The “knucklehead” approach and what matters in terms of health for formerly incarcerated Latino men

Abstract

In terms of the examination of the relationship between masculinity and health, there has been limited exploration of how the ways in which formerly incarcerated Latino men (FILM) construct their masculinities may conflict with public health messages. Using information gained from three years of ethnographic research that was conducted with formerly incarcerated Puerto Rican males in three urban communities in New York City, the authors examine what matters to FILM in terms of their health and well-being and what conflicts exist between public health prevention messages and FILM masculinity. Our results indicate the following: 1) major threats to the health of FILM, such as HIV risk behavior, alcohol and drug use and high caloric intake, are perceived as irrelevant to most of the FILM in the study; 2) young FILM believe that they engage in risky behaviors because of their “knucklehead” mentality and diminish their risks by becoming “street-smart;” and 3) social isolation, loneliness and general risk-taking behavior among FILM are salient issues that have yet to be effectively addressed. Of our sample of 32 FILM, we identified 7 individuals who have transitioned from having a “knucklehead” approach in their lives to possessing a greater sense of awareness of health and social matters. These seven individuals followed either or both of the following pathways: 1) pursuing a college education or 2) becoming community leaders.

Health is an abstract concept in the everyday lives of most young men in the United States. Young men have limited, if any, interest in protecting their health. After all, why should they care about illness? Young people tend to have a very low prevalence of debilitating illnesses or conditions that affect older people, such as cancer or cardiovascular disease, and they are highly asymptomatic to many ailments that affect young people, such as sexually transmitted diseases. Thus, many diseases and conditions are not concrete or meaningful to young people (Armstrong, Kalmuss, Franks, Hecker, & Bell, 2010). Scholars in the field of public health have documented the gap between young men’s actual risks for early mortality, drug dependence, obesity, and HIV/STI risk and their general regard for public health messages about these risks (Lindberg, Sonfield & Gemmill, 2007; Mulye, et al., 2009). In this paper, we examine what matters to formerly incarcerated Latino men (FILM) who have been imprisoned in jails or prison within the past 5 years in terms of their health and well-being and what conflicts exist between public health prevention messages and the “knucklehead” approach to life that is assumed by many young FILM. The concept of the “knucklehead” emerged from the ethnographic fieldwork of this study, and it is defined as the decision-making approach that involves knowingly acting in ways that are harmful or risky in spite of clear awareness of the risks entailed.

There are multiple types of groups of teenaged and young adult men who could have been selected for an examination of the salience of health and public health promotion messages. FILM exist among the lowest in social class and labor force hierarchies in the United States and other countries (Freudenberg, Daniels, Crum, Perkins & Richie, 2005). From a physiological perspective, this age group is one that is presumed to be at the healthiest stage in life, and yet, among heterosexual men, this group has the highest exposure to a cluster of health risks, including HIV/STIs in jail/prison, overdose and chemical abuse and dependence, and head and body injuries that are obtained due to interpersonal violence that occurs prior to, during and post-release (Grinstead, Zack, Faigeles, Grossman & Blea, 1999; Grinstead, Zack & Faigeles, 2001; Ballard, Friedman, Lemon, Stein & Gerstein; 2002; Belenko, Langley, Crimmins & Chaple, 2004; Bryan, Robbins, Ruiz & O’Neill, 2006). These men are also Latinos, which is the ethnic group that has the highest prevalence rates of diabetes and obesity (Cowie, et al., 2006). Thus, FILM represent an ideal case study for identifying how teenaged and young adult males who have high exposure to health threats and have low resources and competing priorities engage or disengage with health matters.

Latinos, as well as other ethnic minority men, are disproportionately arrested and sentenced to prison, serve longer sentences, and have higher rates of recidivism than their white counterparts (New York State Department of Correctional Services, 2007). In 2008, 20% of State and Federal prison populations were Latino (Sabol & West, 2009). The present study was conducted in the South Bronx, Washington Heights and East New York (three low-income neighborhoods in New York City) (NYC Department of City Planning, 2011)). Among Latino groups in the U.S., Puerto Rican males aged 18 to 39 have the highest rate (5.1%) of incarceration, which is more than triple the percentage of non-Hispanic Whites (1.66%), and are the second largest incarcerated group after African American males (10.9%) (Sabol & West, z2009). Rather than focusing on all FILM, this study targets FILM of Puerto Rican descent. While it seems clear that a number of important cross-cultural commonalities characterize many of the different groups that are defined in the United States as Latino, the precise nature of these commonalities among FILM, and whether they extend beyond a common or shared language to the range of intimate behaviors (and associated emotions) that are relevant to FILM’s health risk taking practices, remains unexplored.

Puerto Ricans in the northeastern United States represent a unique epidemiological group. Often referred to as an “air bridge” because of their circular migratory patterns between the U.S. mainland and the island of Puerto Rico, Puerto Ricans have migrated to the NYC metropolitan area for more than a century in major waves, beginning at the onset of the World War I (Deren, Kang, Colón, & Robles, 2007). We focused on Puerto Rican FILM and conducted a three-year ethnography that began in the South Bronx, New York in June, 2006, and lasted until December, 2009. In the following section, we describe the theoretical framework for this study.

Theoretical framework

Gender systems are central to the organization of social relations in all social and cultural contexts. Gender systems are defined as the set of arrangements by which a society transforms biological sex differences into hierarchical differences between men and women in terms of their functions in society. This differentiation is achieved through the institutionalization of gender relations via a range of different social systems, including educational, political and economic systems; formal legislation; and cultural traditions (Rubin, 1984). The gender system in a given setting determines what is socially and culturally expected, allowed and valued in a man or a woman (or a boy or a girl) within specific contexts (Rubin, 1984). While much of the work that focuses on gender systems has concentrated on issues that are related to women, it is important to emphasize that the concept of gender is not interchangeable with women – it refers to both women and men and to the relationships that exist between them (Connell, 1987; Bourgois, 1996). This focus on the centrality of men and masculinity to a broader understanding of gender systems has gradually increased our awareness of the different forms that “masculinity” takes. Different social settings, gendered power differentials, and inequalities shape not only the relations between men and women but also the relations among men of differing social status. Status may be linked to a range of structural factors, including socio-economic status, race or ethnicity, age, and sexual orientation (Connell, 1987). Therefore, growing attention has been paid to concepts such as hegemonic masculinity – a type of normative ideal of masculinity, as articulated in different societies, to which men are supposed to aim to achieve (Connell, 1987), which creates a variety of different forms of masculinity of lesser value and a hierarchy of unequal power relations between men whose masculinities diverge from the hegemonic normative ideal.

FILM occupy a lower position in the social hierarchy of masculinities in the United States because of their ethnic minority status and their systematic exclusion from the labor market. Latino young men are systematically excluded from prime economies that offer sustainability and upward mobility. Instead, they perform jobs that other members of American society will not perform (Kalleberg, Reskin, & Hudson, 2000). Thus, ethnic minority men tend to be at the bottom in terms of labor market stratification (Jacobs & Blair-Loy, 2001). For economically disadvantaged Latino young men (including FILM) who reside in cities such as New York, the discourse of masculinity street culture is in opposition to the subordinate office culture of employment in the service industry (Bourgois, 2003). Poorly paid non-professional employment options in this sector (i.e., mail room clerks, photocopiers and messengers) create a cultural clash between men’s masculinity and the interpersonal subordination that service work entails (Bourgois, 2003). Furthermore, the discrimination that exists in the labor market against employing formerly incarcerated individuals places FILM, in many ways, at a lower stratum in a hierarchy of masculinities that is based on the labor market structure.

At the interpersonal level, FILM deploy a system of gender relations that is based on a hierarchy of respect (Wilson, 1969; Bourgois, 1996; 2003; Ramirez, García-Toro, Velez-Galvan & Cunnigham, 2002). By drawing on the above theoretical framework, we aimed to explore how the pressures of performing a localized masculinity against the realities of ethnic/racial-gender exclusion in the labor market set the backdrop for FILM to deny their health needs, engage in risky practices as ways of coping with exclusion and proving their masculinity to themselves and others, and disregard health-promoting messages. The following section describes the methodology that we used to accomplish the above goal.

METHODS

Investigating the masculinity of FILM in relation to health promotion messages is a challenge, given the multiple social processes that influence health-seeking behavior (Macnaughton, 2008). Ethnography is an ideal methodology for elucidating social processes within a particular culture. The dynamic nature of the ethnographic design can capture multiple perspectives of the social phenomena of study, including the following: the voices of individuals, the interactions between individuals, the external observation of group behaviors, and the documentation of belief systems and their transition to practice (Gutmann, 2004; Fonseca, 2004; Fuller, 2004; Olavarria, 2004). Our ethnography was divided into two components: participant observation of the socialization situations of FILM and key informant interviews.

Ethnographic observations

In this study, we conducted observations in three spaces: 1) a church that was attended by a large number of Puerto Rican FILM; 2) antiviolence youth spaces (“peace zones”); and 3) street corner gatherings that included FILM. We began the ethnography in an antiviolence program in the South Bronx, New York. The above three types of spaces were identified after conducting the first 5 key informant interviews, for which the informants were recruited by the first author during his initial ethnography of street corners in the Bronx, New York. These three spaces were stable socialization points for FILM in these neighborhoods. During each ethnographic observation, the ethnographers collected information and classified it into four major categories: 1) traits: the characteristics of the social scenarios and social actors; 2) activities: the types of socializing and/or commercial activities that take place in these spaces; 3) dynamics: the interactions among group members regarding the control of group conversations, teasing patterns and collective responses to the social scene; and 4) reactions: the non-verbal and verbal reactions that occurred once topics of health were introduced into the conversation by the ethnographer (this introduction was performed after a number of ethnographic observations). Ethnographers wrote down their observations immediately after leaving the observation site, and these records were used for this analysis. Informed consent was not obtained during ethnographic observations of public behavior. This methodology was approved by the Columbia University Medical Center Institutional Review Board.

Key informant interviews (KIs)

KIs are an essential data collection method in ethnographic research and one of the most effective ways of obtaining detailed information about issues of interest in hidden populations (Schensul, 1999). During the course of the initial field observations in the South Bronx, two individuals were identified and agreed to serve as “street mentors” to the first author. The street mentors became research assistants in the field and helped to identify and interview key informants. The KIs ranged in age from 16 to 29 years old (n=32) and were divided into tertiles among three age sub-groups: 16–19; 20–24 and 25–29. Interviews were conducted concurrently with participant observations. Key informant interviewing does not require a specific amount of time or number of interviews (Schensul, 1999). We asked key informants for their assessments of the accuracy of our observations of their perspectives and experiences regarding the salience of health. For those who were interested in health and who took actions to protect their health, we asked about the transition process by which they became aware and conscious of their decision-making with respect to health matters. We conducted two to four interviews per key informant. Key informants were compensated $25 for their time during the second interview. All of the interviews took place while drinking coffee or having a light meal with the participant in a food establishment. The informed consent process consisted of describing the focus of the study, the risks and benefits of participating as a key informant, rights to privacy and confidentiality, and the procedures that would be used for the multiple interviews. Interviews were conducted in Spanish, English, or both, depending on the participant’s choice. The interviews were taped and transcribed within two weeks of the day of the interview. Written parental assent was obtained for youths aged 16 and 17. For all of the names of the key informants who are cited in this paper, pseudonyms have been used to protect informants’ privacy and comply with human rights procedures approval from the Columbia University Medical Center Institutional Review Board (IRB AAAA 7371).

Key informants had served at least 2–3 sentences in jail, and a third of them served time in a New York State prison. All key informants had been released within the prior 5 years. Half of the sample had 1–2 years of high school but only one completed high school. Three quarters of the sample obtained their GED while in prison/jail. 42.3% of the respondents worked full time, while 28.2% worked part-time and 29.5% were out of work. There were 4 ethnographers, including the first author. The informants were males, of a similar age, working class and of Puerto Rican ancestry.

Data management and analysis

Fieldnotes and key informant interview transcripts were entered into ATLAS.ti, a software package that is specifically designed to analyze text data. ATLAS.ti allowed for the coding of textual data by general themes and by specific topics that can be retrieved at the conclusion of the coding for the execution of data analysis. To examine the first study aim, identifying what matters to FILM in terms of their health, we listed each of the issues that were mentioned during the key informant interviews. The first part of our analysis consisted of a thematic analysis (Neuendorf, 2002), for which we generated lists based on the answers to questions about general priorities and FILM’s thoughts and perspectives in regard to health matters. We conducted a similar theme list generation procedure to address the second study aim, which was to explore the reasons for FILM’s risk practices. The second part of the analysis focused on case studies (Yin, 2009), in which we identified case studies of key informants to illustrate central themes. These case studies were selected based on consensus among the authors. In this second part of the analysis, fieldnotes were coded based on the following: 1) how issues of health and well-being were brought into group discussions; 2) health and risky practices observed and 3) group dialogues about health and risk. Consensus was obtained through discussions among the authors. In this paper, we present our findings from both the key informant narratives and the ethnographic observations.

RESULTS

Street survival and use of the body for intimidation

During the interviews, participants discussed extensively how finding and maintaining a job, staying out of jail, and avoiding unnecessary violence in the streets were constant preoccupations for young FILM. Random violence and organized crime were perceived as the most lethal forms of violence and thus became priorities in the minds of young FILM. While uncommon, these types of violence were extremely visible in the community, thus fueling a generalized fear of violence and the perception that New York is a violent city. Thus, it was not surprising that staying alive and avoiding being killed or injured in a fight was the primary health concern reported. “Nothing else matters but surviving,” was the phrase commonly used by the teens and young men.

For example, José was born in Sunset Park, Brooklyn to Puerto Rican parents. At the age of 4, his parents were divorced, and he and his mother relocated to Puerto Rico. At age 7, his mother remarried and they returned to New York. His stepfather was a boxer, and often during the weekends, he “would pound [his] mother out over jealousy and all kinds of ridiculous stuff.” They moved from shelter to shelter until they obtained a place with government assistance. He expressed that “after all that mess, she [José’s mother] started working in real estate, getting her license and became a broker selling apartments and homes.” She also became a “religious fanatic,” and she was very strict with José and his siblings. José rebelled against his mother and his relatives. In spite of his mother’s success, his mother continued to experience domestic violence, which was perpetrated by new boyfriends. A number of other family tensions existed with relatives. José started shoplifting and writing graffiti at age 12. He was convicted and served time in jail at age 16. He served 4 terms in prison. He said that he was a “knucklehead.”

We didn’t know what to do with all that energy. And I was hanging out in big wolf packs of friends and graffiti writers and bombers, fucking going out, stomping out in the streets and just doing – taking over. Going to parties and wilding out and sticking people up and robbing people, and that was it: Building a reputation so people could know not to fuck with you. I believe back then it took me having to get high and get drunk to dare do something too. And being – peer pressure, that was it. When I was younger, at that period, 13 and 14, I was learning the ropes. My father wasn’t around. He didn’t teach me how to be a man. He didn’t teach me what the streets were like. I learned that shit as a fucking innocent Jehovah’s Witness little kid, trying to be good, and having all these mean motherfuckers on the block fucking following you when you’re in your suit and tie and your briefcase, going to fucking – the Kingdom Hall, going to church. And you have a mob of fucking rug rats, street hood rats, following you, telling you, “You think you’re better than us? What do you think ‘cause you got a fucking suit and tie you’re better than us?” And I used to fucking get jumped all the time, got my nose broken. Every time, you know what I’m saying, people in the street, big groups. It was never one on one. I would always get jumped. And I had to fight back and learn how to fight. And I had nobody to teach me none of this, so what I saw off my friends, and I tried to – I went and got a hammer. And the next time somebody came over and tried to rush me, I pulled out a hammer and smashed him in his face and that shit stopped. And nobody ever fucked with me again.

In the social context of the street and prison, young men’s physical bodies became symbols of power. Heavy weight individuals (a.k.a. “big guys”) and lean-muscled types were the predominant body types in the street/jail/prison scene. Young men who had average or skinny body types were generally subordinated to young men who had larger, more powerful bodies in the local hierarchies of masculinity.

In narrating the reasons for dislocating the jaw of another young man in a street fight, Marcos cited his body weight and how he needed to overcompensate for his thinness through intimidation.

I broke that kid’s jaw, it was like intimidation type of stuff. You know what I mean? And who would I intimidate if I was – I would never weigh more, I mean, at my oldest stage I don’t go more than 150. So when I was a kid was maybe, what, 100? You know what I mean or even less than that.

Moreover, obesity was an observable issue among FILM, yet it was rarely discussed among them. Obesity, which was observed among those with high intake of sugary drinks, high caloric energy and muscle-building shakes, and heavy consumption of saturated, fried food was considered normal. In most of the domino games in which we participated, the consumption of orange soda and cola, cases of beer and chips that were topped with ground beef and cheese was high. If the social events were hosted by a family, “arroz con gandules” (rice with pigeon peas) or “arroz con pollo” (rice with chicken) were frequently served. These starch-based foods have a high caloric intake, but they are potentially more nutritious than chips. However, although these foods were perceived as delicious, they were served significantly less often than chips that were topped with cheese, primarily because of the labor that cooking these types of rice required. “It is very easy to ruin an ‘arroz con gandules,’ that’s why I let my wife do it,” said one of the young key informants. In these environments, there was a clear gender division of labor, in which women cooked while men played dominoes or video games.

Young men viewed being too small as a threat in street and prison environments. This threat was more palpable and salient than that of obesity and diabetes. The issue of the intake of unhealthy foods was a major problem for FILM, and the main difference in terms of this problem existed between those men who did cardiovascular exercise regularly (e.g., running) and those who exhibited sedentary behavior in combination with infrequent weight lifting. Most of the young men in the study had older close relatives in the community who had cardiac disease, diabetes and amputations that were carried out because of diabetes. However, young FILM and their friends were not concerned about diabetes and cardiac disease. Frequently, they teased each other about being overweight or underweight, while having social recognition of the need to be accompanied by “big guys” when walking through a potentially dangerous part of the neighborhood.

Body size mattered, but only to the extent of its impact on perceived safety and protection. Based on the data that we have, we do not know if being physically fit increased the size of young men’s social networks of friends or potential sexual partners. However, the intake of unhealthy foods was not only part of familial leisure space but also something that young men took part in after smoking marijuana, and some of them expressed that they overate to make themselves feel better during hard times. For example, Pedro talked about “stuffing” himself with his girlfriend’s nachos con carne (chips with ground beef) and Coronas (beer brand) whenever he had a “really rough” day. In the following three sections of this manuscript, we present our qualitative findings on social isolation, depression and the management of life situations, and the role of “knucklehead” approaches within these areas of young FILM’s lives.

Social isolation, loneliness and depression

The young men in the study expressed that at the moment they entered a correctional facility, they experienced the highest levels of social isolation that they had experienced in their lives, and this social isolation continued post-incarceration. In this section, through 4 vignettes, we will illustrate a common sequence of events that we developed from the narratives of our participants: 1) they felt socially isolated from their families because of violence between parents or between one parent and the children and parental alcohol/drug addiction that existed prior to the men’s initiation into criminal activity; 2) they expressed not “thinking clearly,” “making impulsive decisions,” and often using a “knucklehead approach” to carrying themselves while dealing with their families and their social environments; 3) some felt powerful prior to imprisonment, but the experiences of jail/prison either facilitate a process of reflection and consciousness regarding what they want in their lives or lead to the solidification of their criminal skills; 4) post-imprisonment, most felt socially isolated, lonely and depressed and often engaged in risky activities to cope with their lives.

Mateo’s father was a bus driver for the Metropolitan Authority of Buses in Puerto Rico. Mateo was one of 8 children in his family. Although his father was considered a very successful man in the very poor peri-urban community where Mateo grew up in Puerto Rico, he was an alcoholic and would “beat up” his children and wife on regular basis (almost every Friday and Saturday) and did so with particular emphasis on Mateo. At age 16, Mateo’s father kicked him out of their house. Mateo needed to find a job and a place to live. A street gang from his neighborhood took him in. Mateo proved to be highly organized, and in a short-period of time, he had his own “punto” (street corner drug distribution, in this case, of heroin) and four employees who were under his supervision. He began doing bank robberies, but only carried these out 2–3 times a year. He was a successful heroin drug dealer until the age of 19, when he retired to become a diesel mechanic in a division of the Metropolitan Authority of Buses in Puerto Rico. He wanted to have a job in the formal sector that was less risky than the street. He stopped using heroin, but he expressed that he became an alcoholic. He got married and had 3 daughters. He was a mechanic for 5 years when his mother died. Mateo expressed being very close to her. She died in December, and three months later, while still a mechanic, he organized and conducted a large bank robbery and was arrested and convicted. When asked what his thoughts were about carrying out this robbery after being “quitao” (retired from the street business) for so long, he said the following:

I don’t know what I was thinking. I was in a fog. My mom and all that shit. I got caught because I was stupid. The robbery went well. Nobody got hurt, no bodies. It was clean. I was stupid and bought myself a flashy car and flashy stuff. I was not smart about it. A very daring neighbor ‘me chotio’ (whistle-blew) to the police.

He served 10 years in state and federal prisons. Mateo felt and was considered powerful before entering prison. After prison, things became more difficult. Mateo was caught in a constant cycle of rebuilding a new life. However, because of a lack of stable employment, he reverted to drug dealing as a default source of income and became addicted to substances such as ketamine and heroin. This addiction led him to make serious errors in drug dealing or other criminal activities after major life events. When his father died, he committed a crime, was arrested and served time in prison. Now, Mateo recognizes that he was “depresivo” (frequently depressed) but had not done anything about it.

Every formerly incarcerated Latino man whom we interviewed had come from families in which violence and alcohol dependence fractured their family relations. For example, Lucas was not sure if his father abandoned them or his mother left his father because of his addition to heroin. He grew up between Puerto Rico and New York without a father and around many uncles who were drug users themselves. Lucas did not try to rebuild his life after imprisonment, and he continued what he called “his knucklehead business as usual.” He grew up in one juvenile correctional facility after another. He became the main distributor of heroin within correctional facilities. Lucas fell in love and married a woman, and he tried to change for her but was unsuccessful:

My wife and I were girlfriend and boyfriend since we were kids. But she couldn’t take this impulse I have for the street life. We had two children. I tried to change but was not able to. She disagreed with the life I was carrying on. That thing about being in the peripheries, in the underground is a life that she didn’t want. Truthfully, I understand. We had a house, a home and everything, but the marriage didn’t last long. A healthy, clear-minded woman. A woman that I still love…Why would someone be with a man like me, with so much delinquency? We broke up and followed our own paths. I continue alone. I am always alone and lonely. That’s my life of loneliness and doing my things.

Social isolation from family seems to begin prior to incarceration and becomes evident after imprisonment.

My family, um, they all say the same, ‘Oh he’s always the same, nothing’s gonna change, he’ll be back in jail.’ My mother fine, I believe my mother back me up whether it’s good or bad. My other family members, it just keep it on that ‘he’s a no good, you know, and why help.’ This affects me hard because … it just drives me to believing those outsiders instead of family members.

“Only people who have been imprisoned understand the type of isolation we feel and how lonely one is in his own head,” said Juan, one of our study participants. The stigma of imprisonment that stems from family members introduces additional levels of social isolation, which produces further loneliness. Young FILM had to reconstruct their masculinity during prison and after prison. For young FILM, prison became their “Man,” or their oppressor, and the streets were constructed in juxtaposition as their female, seductive lover. Pedro’s story captured the essence of these dynamics. He described imprisonment as a process of feminization in which he became a young, vulnerable woman at the hands of the Man (the NYC Department of Corrections). This dynamic became the on-going framework that he utilized to understand the relationship between inmates and correctional officers (COs).

I was taken to a new environment, the PRISON SYSTEM OF NEW YORK. Being it my first time in jail I was as scared as a virgin during her first time having sex. I figured that the correctional system would be there if anything would happen I couldn’t handle. But I was wrong. It was that same system that created a new monster.

Rather than creating an environment of change and self-reflection for Pedro and the other inmates, their incarceration further cultivated an environment of violence and “knucklehead” behavior. During a routine dormitory search, COs rushed into Pedro’s cell while shouting, “everybody to the wall, no one looks back!” Pedro described that “not looking” would had been dangerous in the street, so he looked back. At that moment, his face was smashed into the corner of the locker by a CO, and he fainted. After this experience, Pedro quickly learned that his biggest enemies in prison were not the inmates, but rather, the COs. Exiled from his family who neither called nor visited him, and fearful of the COs, Pedro served his first prison sentence “in anger, silent sadness and dreams of better thoughts on life.” Demoralized from his experience in prison, Pedro returned to the streets upon his release because the streets “loved me, respected me and gave me what I thought I needed.” This paradoxical relationship between the street, which was the number one threat to the men’s survival, and the streets as their saviors and loving seductive partners was a consistent theme that points to the many contradictions that were salient for our study participants.

Except for 2 of our participants, none expressed being depressed. However, 4 out of 10 of the men in the study expressed one or more of the following: feeling irritable frequently, feeling as if they are in a fog, having urges to beat or harm someone when they were sad, having thoughts of ending their lives, having constant thoughts of death and dying, and feeling helpless about the future. The above suggests that mental health issues, such as depression that results from social isolation, loneliness, family or having “broken” families; FILM’s perception that death is inevitable and the fear of becoming a “junkie” (categorized as a homeless addict); and basic mortality (or survival) were the young men’s main concerns regarding health and well-being.

Stress during and post-imprisonment

Imprisonment was perceived as an experience that causes stress beyond confinement itself and as a major change in the state of their current and future lives and their masculinity. Omar expressed that

I believe prison is, in itself, something that breaks any man, you know what I mean. It’s made to break a man. Prison is something that a lot of us could live in it like I lived in it, and I could tell you I know how to live in prison. I don’t have a problem with living in prison, but now, I do fear dying in the prison and not having the loved ones by my side. That’s my fear, you know what I mean.

In reflecting about prison terms, which are also known as “bids,” Juan said that the “first thing men do is stress about their girlfriend, their wife, their woman – whatever you want to call it – their spouse, their shorty because they figure they don’t want this person to actually cheat on them, but that’s something that’s gonna happen eventually because if you have to do a long bid, everybody has their needs, everybody needs love and attention.” He continues:

So basically you gonna lose your wife. And this is just my assessment - is how I see it. I might be wrong. I’m not out there. I’m not in everybody’s head out there that’s doing time or has done time before. But I would say one in a million women that would wait for you if you’re doing a bid. Mainly not because she didn’t love you, not because she didn’t want to wait for you, but because she’s a human being; human beings have needs. I personally - when I have to do a bid - I call up my, whoever I’m with at the time, and tell her, “Listen, it’s time to let you go because I don’t want to sit in jail and worry about who’s my girlfriend with. Is she with somebody? What is she doing? Why doesn’t she pick up her phone? “ I have enough problems of sitting in there and worry about what I got to do in there.

While a number of study participants commented on their strategies for addressing the above stressors, most “stewed” on the issues and try to avoid thinking about their wives, girlfriends, friends and families. Furthermore, after release from incarceration, the stress of re-entry into the community became intertwined with the social expectation that ex-prisoners were powerful men who survived prison. In this regard, Juan said the following:

It’s like you wake up and you can’t brush it off. It didn’t make me feel any good. Like some people say, “Oh, I just came home. I’m the man.” And they’re all big and what not or whatever ‘cause they’re not in there. It doesn’t make you a man ‘cause you came out of there, and people knew that you were in there for whatever reason and now you supposed to be big again. ‘Cause actually you’re not, you’re the biggest sucker out here ‘cause now you have to try to find a way to start from scratch to get your life back together. …There’s no way you can get used to going to jail. Because I’ve gone to jail a dozen times, and I can never get used to it. Every time I go in there, right away, I get stressed out.

We observed three manners of handling the stressors that existed post-incarceration: 1) practices that validated masculinity; 2) the “knucklehead” mentality, not thinking straight, and risk-taking; and 3) addressing the stressors and refocusing on productive masculinity.

Healthy and risk-taking practices for validating masculinity

Young men in our sample described a series of practices that were just “part of being a man,” and “the things that you do to blow steam.” These practices were juxtaposed with “knucklehead things” that one did to handle life. Common healthy practices for dealing with stress were as follows: exercise, playing video games, eating, watching TV and movies and visiting and talking to friends of ‘confianza’ (trust). However, to handle what were considered real problems, such as major arguments with family members, losing a job, being rejected from a job opportunity or the death of a family member or friend, young men often used drugs and sex as strategies. For example, Galindo made note of the following to us:

At night, I like to go to bars. I leave around 7, 7:30 and straight to the bar. Life is really hard these days. That’s how I deal with things. Once you are there is always a woman and that’s how you really forget things. You get together with them that night and move on. Nothing like alcohol and sex to forget things. To get a break.

Galindo and a number of the young men in the study had steady concurrent partners. That is, they had a girlfriend or wife and had one woman with whom they had sex and socialize frequently and simultaneously. For example, Galindo discussed having a girlfriend, Rosa, because this woman despised his current girlfriend Ana, and Rosa disliked Ana and “just wanted to fuck with her.” It was interesting how frequently in the narratives the men thought of themselves as having no control over their sexuality and believed that women suddenly came across their paths. For example, Omar said that

I was just chilling one day, minded my business in the computer, and MySpace actually was, and I see a friend request and the next day I was thinking about the person who sent me the request on MySpace, when I came to find out it was the girl I knew at McDonalds, so, boom! From there, I’ve been chilling minding my own business, I always liked her as a young woman and everything. We started going out.

Concurrent sexual partnerships are risky in terms of sexually transmitted infections and reproductive health. The young men in the study were only concerned about reproductive health when it related to having sex with someone other than their regular, primary partners, such as wives or girlfriends. “I don’t want ‘Sarita’ to catch me doing another woman,” Carlos said, in reference to the threat of his girlfriend finding out that he had had sex with another women. His primary concern was not contracting HIV or an STI, but rather, that his sex partner would become pregnant and this discovered as having an affair. However, in spite of this fear, reproductive control was usually considered the sole responsibility of female partners, regardless of whether the woman was the man’s primary sex partner.

During discussions about sex and reproductive health among young FILM, HIV/AIDS and sexually transmitted infections were recognized as concerns when having sex with sex workers or with a woman who is labeled “cuero” (literally, “leather” in Spanish, a Puerto Rican street term for a woman who is perceived to be promiscuous). For example, Galindo discussed how common it was to use sex workers in groups of young men during the months after release from jail or prison. HIV/AIDS was viewed as a disease that affected men who have sex with other men (including in prison), self-identified gay men, and injecting drug users. Sexual health concerns were not discussed among young FILM except when alerting someone that a potential partner was a cuero. To a large extent, sexual risk taking was considered part of the general, acceptable practices of being young men. It was risky to do something while “not thinking straight” or out of stubbornness. In the following section, we describe these practices.

“Knucklehead”, not thinking straight, risk-taking

Young men considered using a “knucklehead” approach to handle things as risky, and as not fully thinking straight or considering the consequences of their practices. At the start of the fieldwork, Pedro, one of our key informants, told us that the reason that he had performed a lot of risky actions and ended up in jail was not because of his local drug dealing business but because of consciously overlooking the potential negative consequences of deviating from his rules in conducting drug dealing. This is how Pedro defined “acting like a knucklehead.” For example, Kanky, a New Jersey-born Puerto Rican, talked about being a “knucklehead” when handling a verbal argument with his girlfriend while visiting friends in Washington, D.C. Kanky abruptly left the house where they were staying and drove to a bar. There, he started drinking and smoking marijuana with strangers. Later that night, someone gave him a cigarette that contained PCP. He was not aware of what the cigarette contained at the time. He “got really high and went crazy.” Kanky left the bar and woke up the next day in his car in the front yard of a house in Maryland. Minutes after waking up, the police arrested him. Kanky stated that the officers said that they had been tracking him from D.C. because he had damaged several cars and collided with a number of structures. The police officer said that “it was a miracle you didn’t kill anyone.” Kanky served time in federal prison for this crime. He considered this one of the “many stupid things [he] did for not thinking straight, for being one who accepts drugs from strangers alone rather than with friends to have your back.”

Although Kanky’s story may seem out of the ordinary, it was a common type of narrative among the young men’s accounts of their “knucklehead” experiences. Something that started as a routine problem, difficulty or challenge resulted in something that had major consequences on their lives. For example, knowing for a fact that a car was stolen, Marcos drove the car with his friends, crossed the state line, and went to a town nearby. Marcos was 18, his friends were minors, and he had a criminal record for stealing cars. He did not steal this particular car. Marcos said that they were stopped by the police for “driving an old car with out-of-state plates.” He was arrested, and one of the minors accused him of having stolen the car that they were driving. As another example, Roberto had just finished his drug dealings for the day and came across a young woman from the neighborhood whom he liked. They started flirting, and he walked her to her place.

So, I have 4 bags hidden, and there is a guy behind us. The guy started talking to us: ‘I am sick dude, I need something.’ I just ignored the guy. I don’t know that guy at all, so I don’t care about him being sick. I don’t give a shit. I told the guy I have nothing. But then, the girl was like, show some compassion. And she kept going and going on it. She was sweet and hot, and guess I was horny or something. The thing is that I got one of the bags and placed it in her hand, and said to her ‘You sell it to him if you care so much about the fucker.’ She did. We passed the corner of 109^th street, and right there, they throw themselves at us. I told the undercover, I have nothing on me, brother. I was able to get rid of the 3 bags [of drugs] left before they got us on the ground. I told her right there. I fucking knew it that this guy was not right.

Roberto attributed the above to letting his “dick do the thinking.” He did 11 months in jail because of this event, which he claimed was caused by being “horny and not-thinking straight.” Risks can be minimized by “not being a knucklehead,” said José. As with any child who is transitioning to adulthood, the teens in our study were undergoing a period of rebellion and adaptation to adulthood. Some of the teens labeled this stage “knucklehead business.” José defines this stage as “feeling this inner challenging thought towards my older brother, which resulted in a physical confrontation, which I would compare to the cub challenging the older male of the pack, pushing the envelope or testing the water; or in simplest terms, seeing if they can get away with things also” (José). This rebellion against adults, the system and other structures of social order is not unusual for teenagers in other classes or ethnic groups. However, these teenagers were at greater risk because they often lack the safety net of strong community support systems and family network ties. Regrettably, arrests and imprisonments were very common experiences for youth in our study neighborhoods. When talking to Luis, he expressed a sense of pride about getting arrested. He noted that “being arrested by the NYPD and going to central booking is like the bar mitzvah of kids in the hood.” Thus, this cultural commentary presents the experience of being arrested as a symbolic milestone transition from childhood to Latino manhood.

Study participants described acting like a “knucklehead” as being an integral part of their development as men. In spite of this sentiment, some study participants were able to transition from “knucklehead business” to the confrontation of stressors and refocusing on productive masculinity.

Beyond “knucklehead” business and productive masculinity

Of our sample of 32, we identified 7 individuals who had moved from the use of a “knucklehead” approach in their lives to the possession of a higher sense of awareness of health and social matters. These seven individuals followed either or both of the following pathways: 1) pursuing a college education or 2) becoming community leaders.

The pursuit of higher education and employment in the formal sector were common goals among most formerly incarcerated young men. Tito has an undergraduate degree from City University of New York, and currently has a stable job. Tito served 5 years in prison. For a period of time, he said that he was in and out of central booking (where one spends 3 nights while being arraigned). He attributed his current position to two factors: 1) his participation in a prison-based program and 2) becoming a member of a prisoners’ rights organization.

I was also put through a program called CASES, Center for Alternative Sentencing and Employment Services. And that program actually let me see life in a different way. Job placement, employment – they could help me ‘cause they put me in very good places to internship at. They helped me get my GED, basically find stability, put some income in my pocket that didn’t mean having to hustle drugs or rob somebody for it. It helped take responsibility for myself and my actions. And I say that program really helped detour me to me where – and bring me back onto the path that I needed to be on. […] I became a member of what is the Association for Pro Inmates’ Rights, like an organization – a street organization and a prison organization that here, in the United States, has been categorized as a gang. But within our country, Puerto Rico, it’s actually recognized by the Puerto Rican Senate as an inmate rights organization. But here, it has been criminalized by the system. But it was an organization that actually helped me since I entered, since I became a part of that, it helped me make a difference in my community. It gave me the opportunity to give back. It gave me, you know what I’m saying – it helped me find my voice.

Tito, Pedro, Mario and others talked about becoming productive men who “make a difference in others’ lives.” At a very young age, Pedro’s mother became dependent on heroin and other drugs, which destroyed his nuclear family structure. He dropped out of high school and became a leading figure in heroin distribution in the communities where we conducted our study. Pedro subsequently was able to transition from drug dealer to community leader by joining rights movements in prison. While serving his last prison sentence, Pedro described being able to give up his “knucklehead” approach to life on the street to become a person who puts his family, his son and his community first. With the help and advice of older inmates and prison-rights community-based organizations, Pedro was able to stop the self-destructive cycle that had confined him.

My way hurt me too much. My way never took no where different. I no longer feared the pains of change because my pain of remaining the same became greater than the pains of change. I vowed to fight against the feelings of loneliness. My life still had a chance and nothing or anyone would take it from me again.

At the age of 20, Pedro developed a critical consciousness about individual actions and their repercussions and about the many social injustices that youth and men such as Pedro face every day. However, this consciousness was not created as a result of the correctional system, which taught vulnerable men new ways to be criminals. Rather, this self-awareness was encouraged by the networks of prisoners’ rights movements to which Pedro exposed himself. Since his self-discovery, Pedro became a leader in pro-prisoners’ rights initiatives and in the promotion of healthy social and physical environments in low income New York City communities.

Stories such as Pedro’s were not unique. It was not uncommon for FILM to become actively involved in their community and in issues of social justice after recognizing the self-destructive nature of their “knucklehead” street behavior. Mario, another man in this study, also described his desire to work as an advocate on behalf of marginalized communities.

Community leader me, que vacer (yeah right)! I never abuse or took advantage of the weak. But yea my fight is against abuse no matter what it is it can be from hunger to police abuse I will always say presente (present).

In addition to seeking employment in the formal economy upon release from prison, many young men such as Pedro and Mario also mobilized to advocate for prisoners’ rights. Their work often involved the education of formerly incarcerated groups in job searching, job security, and government assistance and organizing around issues of community health, increasing education, anti-violence programs and environmental justice for low income communities.

DISCUSSION

In this study, we aimed to examine how the pressures of performing a localized masculinity against the realities of ethnic/racial-gender exclusion in the labor market set the backdrop for the engagement of FILM in risky practices as ways of coping with exclusion and proving their masculinity to themselves and others. Our exploratory study findings suggest that, among FILM, one of the major barriers to receptivity to health messages is the “knucklehead” approach that is commonly used among young FILM. The “knucklehead” approach can be interpreted as both a myopic and gender normative model of decision-making and practice. The “knucklehead” approach is myopic because young FILM prioritize instant gratification over long-term consequences. The “knucklehead” approach also embodies a context-specific pursuit of men’s localized masculinity. Older FILM in our study who became prisoners’ rights activists have made connections between using a “knucklehead” approach to handle pressures (e.g., street survival and obtaining a job in a market that is discriminatory against males who have criminal records), and the consequences, which primarily involve placing themselves in risky situations as ways of coping (e.g., having sex while intoxicated with partners of unknown HIV status) and risky practices (e.g., overeating fried food). This group of activist FILM has turned their marginalized status on its head and uses their status as a point of social mobilization to reconstruct their collective social consciousness. This process is similar to social movements, e.g., the Black and queer movements in the United States, in which the marginality of those involved has represented a source of empowerment (Porta & Diani, 2006; Gamson & Moon, 2004). By minimizing “knucklehead” actions and increasing their participation in local political social justice processes, these men have improved their sense of community, reduced their own exposure to risk, and become more receptive to health matters.

The “knucklehead approach” is not a universal term among FILM. The aim of this analysis is not to establish the “knucklehead approach” as a unique, bounded social phenomenon. Using the concept of the “knucklehead”, a term that is commonly used among our participants, helped us capture the central idea that there is a maturation process that is occurring for these young men, and that they often understand that their decisions are foolish even as they enact them.

Our findings suggest that young FILM are aware of six social and mental health issues but do not necessarily have the tools to address them: reconfiguring their entry into the labor force post-incarceration, social isolation, loneliness, depression, stress management and unhealthy risk practices. These issues are not independent but, rather, are interrelated in the lives of young FILM. During incarceration, FILM had to reconstruct their masculinity to suddenly loosen their position of social power as men and become subordinate men. Surviving in prison becomes a new priority, whereas assuming a “knucklehead approach” diminishes the likelihood of survival and early release because a “knucklehead approach” leads to rebellion against the structures of order that are established by both the departments of corrections and in-prison networks. However, while reconfiguring the self to become a subordinate, the young man must retain a sense of power and dominance so that he will not to be abused within the prison environment. Balancing a subordinate masculinity while also having to exert power and control to survive in the prison environment is likely to create stress (Kimmel, 2008). Post-release, men have to once again reconfigure their masculinity and assume a new position of power in the sense that surviving prison (whether for 1 year or multiple years) is seen as heroic in the street environment (Freudenberg, Daniels, Crum, Perkins & Richie, 2005). However, this position of heroic power hides the internal conflict between wanting to engage in practices that further solidify their masculinity as powerful agents and the constant fear of going back to prison and feelings of being rejected from the formal economy because of the stigma of incarceration.

This study has several limitations. This study was an ethnographic study that included 32 key informants and ethnographic observations of social dynamics. Therefore, findings from this study must be considered as preliminary indicators of potential central issues in the study of the receptiveness of health messages for formerly incarcerated populations. This study focused on masculinity and social relations in networks of formerly incarcerated young and adult men. Because of this focus, we explore FILM’s perceptions of health matters and their healthy or risky practices from their own perspectives. To fully examine the impact of “knucklehead” approaches on the creation of resistance to health promotion messages, a more comprehensive research design would also identify specific public health campaigns and examine the compatibility, retention and application of specific health messages. Thus, further research is needed for a comprehensive understanding of the reception of health promotion messages to be reached.

Our study has not produced sufficient data for determining whether duration (e.g., 3 months to more than 10 years), type of incarceration (e.g., county jail, state prison, or federal prison) or frequency of incarceration has an impact on the likelihood of re-engaging in rebellious, “knucklehead” approaches post-incarceration. Our data indicate that what appears to make a difference is whether the young man is able to achieve a different social consciousness during the period of incarceration by, for example, formally engaging with a prisoners’ rights movement or other types of mentorship. Further longitudinal research is needed to examine how post-incarceration configurations of masculinity change through time and impact health practices.

Our participants’ accounts strongly suggest that FILM experience extreme levels of social isolation during and after incarceration. Loneliness and substance use are on-going threats to the mental health of FILM prior, during and after incarceration (Valera, Epperson, Daniels, Ramaswamy & Freudenberg, 2009). Going to jail or prison is a traumatic life event. Although surviving the system is viewed as heroic by our study participants, the effects of prison time are long-lasting post-incarceration (Freudenberg, Daniels, Crum, Perkins & Richie, 2005). In fact, loneliness is not only a predictor of depression among men but also a strong determinant of health risk practices and poor health-seeking behavior (Hermann & Betz, 2006; Torres & Gore-Felton, 2007, Schultz & Moore, 1986). Loneliness is not the sum total of young FILM experiences. Stigmatization, isolation, lack of social support, hopelessness, fear and trauma are likely to be central factors that affect the mental health and well-being of young FILM. Being able to recognize symptoms of depression or post-traumatic stress disorder post-incarceration are potentially central health promotion messages that are urgently needed for this population.

Health matters are minor concerns to young FILM. Paying attention to young FILM’s personal perspectives regarding “knucklehead” behavior and the importance of building a consciousness of respect for the self and the collective can be useful strategies in fostering receptivity to health issues. Reconceptualizing the content of health education messages for young men by moving beyond basic factual information to the confrontation of central issues that matter to young FILM, such as social marginalization and loneliness, can also be a potentially effective strategy. Finally, older, activist FILM in the community may serve as effective, culturally appropriate conduits of health promotion messages for young FILM.