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. Author manuscript; available in PMC: 2022 Mar 1.
Published in final edited form as: Soc Sci Med. 2021 Jan 29;272:113718. doi: 10.1016/j.socscimed.2021.113718

The role of stress and absence: How household member incarceration is associated with risky sexual health behaviors

Erin J McCauley 1
PMCID: PMC8562991  NIHMSID: NIHMS1748807  PMID: 33561572

Abstract

Sexual health is a critical indicator of wellbeing with consequences for population health. However, little is known about whether and how household member incarceration affects the sexual health behaviors of young adults. This study seeks to assess the association between household member incarceration and sexual health behaviors and provides an initial test of mechanisms. Drawing upon data from the NLSY97, this study estimates the association between household member incarceration and sexual health behaviors using linear probability models, and then re-estimates these associations using two alternative comparison groups; 1) youth who experienced other forms of stress, and 2) youth who experienced other forms of family absence. Results indicate that household incarceration is positively associated with a higher risk of reporting sexual intercourse with an intravenous drug user net of individual and family characteristics and is negatively associated with condom use net of individual but not family characteristics. The results also show that the associations between household member incarceration and sexual health behaviors may be attributable, at least in part, to the well documented stress associated with incarceration. Yet, the results provide little evidence that absence is a pathway linking household member incarceration to risky sexual health behaviors. It is possible that household member incarceration is linked to deleterious outcomes for youth through different mechanisms than parental incarceration given the differing roles of parents versus other adults in the home. Future research should explore the pathways linking household member incarceration to health risks for youth and consider household member incarceration as a unique family stressor.

Keywords: Household member incarceration, Sexual health, Sex with IV drug user, Condom use, NLSY 97

Sexual health behaviors are critical in shaping population health, and play a central role in health disparities (Douglas and Fenton, 2013), trajectories of physical health over the life course (Diamond and Huebner, 2012; Liu et al., 2016), and general wellbeing (Woloski-Wruble et al., 2010). Research to date has identified a host of factors which increase the probability of engaging in risky sexual health behaviors, including socioeconomic disadvantage (Browning et al., 2008; Carlson et al., 2014; Winter et al., 2016), and adverse childhood experiences (Berenson et al., 2001; K.Chung et al., 2010; Smith et al., 2006). Given the importance of sexual health behaviors for population health, developing a more comprehensive understanding of the causes of risky sexual health behavior is an essential step in promoting health equity. Household member incarceration is a childhood risk factor that has become increasingly common within the United States, yet little is known about whether children’s experience of household member incarceration affects sexual health behaviors, and if so, how. This study examines how household member incarceration shapes sexual health behaviors into early adulthood and explores two potential pathways which explain this pattern of risk.

The United States has the highest incarceration rate in the world, with nearly half of Americans experiencing the incarceration of a family member in their lifetime (45%) (Enns et al., 2019). Incarceration is a stressful event for families, which can cause trauma and should be considered a serious childhood risk (Arditti, 2016; Arditti et al., 2004; Western et al., 2015). Incarceration also results in family separation, which can strain parent child relationships, undermine the stability of child care, and diminish household income (Arditti et al., 2004; Schwartz-Soicher et al., 2011; Shlafer and Poehlmann, 2009). The consequences of incarceration on families are particularly acute for children of incarcerated parents. Children of incarcerated parents are more likely to experience poor physical health and mental health (Lee et al., 2013, 2014; Turney, 2014, 2017; Turney and Wildeman, 2015; Wildeman et al., 2014, 2018). Children who experience household member incarceration are also more likely to experience socioeconomic disadvantage and academic difficulties (Haskins and McCauley, 2018; Haskins, 2014, 2015; Haskins et al., 2018; Nichols and Loper, 2012; Turney and Haskins, 2014), factors which present their own risk for poor health outcomes (Duncan et al., 2010; Finch, 2003). Despite well-documented connections between household member incarceration and health, consequences for sexual health have received far less attention in the literature – a notable gap given the pivotal role that sexual health plays in population level health and health promotion (Douglas and Fenton, 2013).

Initial investigations of the associations between household incarceration and sexual health generally support the claim that household member incarceration poses a unique risk for sexual health. Household member incarceration is positively associated with teen pregnancy among females (Whalen and Loper, 2013), risk of contracting an STI (Le et al., 2019), and number of sexual partners (Heard-Garris et al., 2018), and is negatively associated with age of sexual onset (Le et al., 2019). While an important first step, these studies are largely associational, documenting a link between household member incarceration and sexual health behaviors without specifying or evaluating the potential mechanisms. Consequently, the question of how parental incarceration affects sexual health behaviors remains unanswered. In order to progress understanding in this area, this study will explore the processes through which incarceration shapes intergenerational sexual health.

Explicating the pathways linking household incarceration with sexual health behaviors is particularly important given the numerous barriers to healthcare utilization and access faced by children of incarcerated family members (Heard-Garris et al., 2018; Turney, 2017). Improved understanding of these causal mechanisms is crucial for both policies and prevention efforts aimed at improving population health and limiting the broader consequences of incarceration on families. Three mechanisms are thought to account for the intergenerational consequences of incarceration on families: stress, separation, and stigma (Geller et al., 2012). This study will examine the roll of stress and separation as two potential mechanisms linking household member incarceration and sexual health behavior. Nearly half of the effect of parental incarceration is accounted for by stress and separation, after adjusting for observed differences (Geller et al., 2012).

This study estimates the association between household member incarceration during adolescence and sexual health behaviors into early adulthood. First, I will estimate the association between household member incarceration and sexual health behaviors adjusting for observable characteristics using a comparison group of youth who did not experience household member incarceration in the same time period. Second, I will re-estimate these associations using two alternative comparisons groups: 1) youth who reported other forms of stress during the same period and 2) youth who reported other forms of family member absence during that same period. In essence, I examine if familial stress or absence accounts for the association between household member incarceration and sexual health behaviors, or if there is a persistent effect of household member incarceration which is not explained by the stress and separation mechanisms.

1. Background

Household member incarceration is an increasingly common event. Forty-five percent of Americans report ever having an immediate family member incarcerated in prison or jail (Enns et al., 2019). Although high for all groups, this risk is particularly acute for Black (63%) and Hispanic (48%) individuals and those with lower levels of education (Enns et al., 2019). Point-in-time estimates of connections to prison incarceration also suggest that exposure to household member imprisonment is high and unequally distributed (Lee et al., 2015). Nearly 44% of Black women have an imprisoned family member and Black women, compared to White women, have between five and nine times as many imprisoned people in their social network (Lee et al., 2015). Household member incarceration is a common and unequally distributed event which has lasting implications for health.

1.1. Linking household member incarceration and sexual health

As articulated by Turney (2014), the stress process theory provides a helpful lens for considering how incarceration, as a social factor, can shape health intergenerationally. The stress process theory posits that disadvantage at the individual, family, and community level differentially exposes individuals to social stressors which have negative implications for health (Pearlin, 1989). Children in households experiencing incarceration face individual level stress on several fronts (e.g. uncertainty about the future and the stress of ambiguous loss (Bocknek et al., 2009)). Research has also found that household member incarceration causes familial level stress (Foster and Hagan, 2013; Turney, 2014), including disruptions to parental relationships (Massoglia et al., 2011) and decreased economic resources (Schwartz-Soicher et al., 2011). Approximately half of parents incarcerated in state prisons were the primary financial providers for their minor children prior to incarceration, resulting in lost income (Glaze and Maruschak, 2010).

The association between household member incarceration and sexual health may also be explained, in part, by the absence of the incarcerated household member. Approximately half of parents incarcerated in state and federal prisons had less than one in-person visit with their child (Glaze and Maruschak, 2010), representing a significant disruption to familial relationships. Family relationships, such as parental-child closeness, parental supervision level and strategy, and parent views about sexual intercourse, are strong and consistent predictors of teen pregnancy (Miller et al., 2001) and use of contraception (Jiskrova and Vazsonyi, 2019). Familial incarceration may shape sexual health outcomes by drastically reducing parental contributions and guidance to children’s health behaviors.

It is also important to consider that incarceration is unequally distributed in two important ways—across social groups (Wakefield and Uggen, 2010) and geographically (Shannon et al., 2017). Neighborhoods which have high rates of incarceration also tend to have lower social capital (Rose and Clear, 2003) and the collateral consequences of incarceration spill out to communities (Haskins and McCauley, 2018; Hatzenbuehler et al., 2015). This perspective suggests that in addition to stressors within the household, youth who experience household member incarceration are likely to experience compounded stressors across multiple socioecological levels. This means that the consequences of risky sexual health behaviors may be more stark for children in households which experience incarceration, as they often lack access to adequate preventative and needed health care (Turney, 2017).

1.2. Importance of sexual health behaviors

In this study I explore the relationship between household member incarceration and four sexual health behaviors: 1) having sexual intercourse with an IV drug user, 2) having sexual intercourse with a stranger, 3) having more than 10 sexual partners, and 4) the proportion of the time respondent’s used a condom during sexual intercourse. Sexual intercourse with an IV drug user increases risk of contracting HIV (Battegay et al., 2004; Celentano et al., 2008; Singer et al., 1992), Hepatitis C, and other sexually transmitted infections (Galea and Vlahov, 2002). Reporting sexual intercourse with a high number of partners also increases the risk of contracting STIs and pregnancy (Rogers et al., 2002). Having sexual intercourse with a stranger is considered a risky sexual health behavior is because it is associated with STIs and difficulty in tracing STIs (Feinstein et al., 2018; Tanfer et al., 1995). Risky sexual health behaviors have implications for population level health, especially for infectious disease prevention (Douglas and Fenton, 2013).

Three articles have examined the association between household member incarceration and sexual health. The first focused on pregnancy and found that knowledge of household member incarceration increased the predictive power of teen pregnancy among females (Whalen and Loper, 2013). The second examines the effect of parental incarceration on sexual onset and STIs finding increased risk (Le et al., 2019). The third examined health care usage and unhealthy behaviors in young adulthood (Heard-Garris et al., 2018). Applying multivariable logistic regression, the authors found that parental incarceration was associated with forgone health care, increased prescription drug abuse, and a high number of sexual partners (Heard-Garris et al., 2018).

These studies provide important evidence to support the hypothesis that household member incarceration is related to risky sexual health behaviors, and in doing so, provide a foundation for the investigation of pathways through which this effect occurs. Identifying mechanisms behind the effect of household member incarceration is key to understanding the collateral consequences of incarceration. This study takes the first steps to identifying the process through which the phenomenon of mass incarceration, as a core institution in the U.S., shapes sexual health intergenerationally and contributes to population level health disparities.

1.3. Identifying pathways

As previously argued, separation and stress are likely pathways behind the effect of household member incarceration. This study will test if the associations identified between household member incarceration and sexual health are explained by the stress of the experience of household member incarceration, the absence of a family member during a crucial developmental period, or some other unique characteristic of incarceration. It is plausible that separation and stress are pathways behind the effect of household member incarceration on sexual health behaviors. Research has found that parental absence is associated with increased risk of teenage pregnancy and early sexual onset (Ellis et al., 2003), in addition to a variety of other disadvantages (Amato and Cheadle, 2005; Huurre et al., 2006). Trauma and stress are linked to risky-sexual health behaviors, employment difficulties, and delinquency (Sansone et al., 2012; Smith et al., 2006). One study found that stress is associated with risky sexual health behaviors, including having sexual intercourse with a stranger and IV drug users, in addition to reporting a high number of sexual partners (Berenson et al., 2001).

While the existing studies in this area provide evidence to support a link between familial incarceration and sexual health, research has yet to tease apart the role of familial incarceration from the accompanying stress and separation. Stress and separation are likely mechanisms that contribute the detrimental effects of familial incarceration; however, this link has yet to be empirically tested. This study will take steps to address these gaps in the literature, exploring pathways behind the negative effect of household member incarceration on risky sexual health behaviors.

2. Data and methods

I examine if household member incarceration is associated with sexual health behaviors, and then test if these associations are explained by household member stress or absence using alternative comparison groups. This study uses data from the National Longitudinal Survey of Youth (1997) (NLSY 97), a longitudinal dataset which follows youth from ages 12–17 through early adulthood. The study is ongoing, and the most recent wave of data was collected in 2015–2016 when youth were aged 30 to 36. Nearly nine thousand youth are involved in the study (N = 8,984) and approximately 80% were interviewed in the most recent wave. The NLSY 97 is funded by the Bureau of Labor Statistics and aims to collect data on youth’s employment, education, households, family formation, health, crime, and attitudes. More information can be found about the data at https://www.nlsinfo.org/content/cohorts/nlsy97.

In 2002 and 2007 participants were asked a cluster of questions about whether they had experienced various stressful experiences in the five years prior, including if they had experienced the incarceration of a household member. I use this cluster of questions to develop the independent variable (household member incarceration) and to develop the alternative comparison groups (other stress and other family member absence). This process is described in detail in the analytic strategy section. For the independent variable, anyone who marked that they had experienced household member incarceration in the five years prior to 2002 and 2007 (i.e. between 1997 and 2007) were considered to have experienced household member incarceration. The question was phrased, “In the last five years, has an adult member of your household (other than yourself) been sent to jail or prison?”.

This study examines four dependent variables. Three of the dependent variables are dichotomous, with 1 indicating yes and 0 indicating no; if the respondent has ever had sexual intercourse with a stranger, if the respondent has ever had sexual intercourse with an IV drug user, and if the respondent has had ten or more sexual partners. Participants who reported having sexual intercourse with an IV drug user or with a stranger between 2007 and 2015 (i.e. between when the independent variable was measured and the most recent wave of data) were marked in the affirmative. The fourth dependent variable is the proportion of the time in the past year that the respondent reported using a condom during sexual intercourse. This variable was measured in 2015 during Wave 17.

Control variables focus on the respondent and their family. Individual controls, used in Model 1 (M1), include age, gender, race (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic other), citizenship, and a binary indicator reflecting prior arrest. Family controls, used in Model 2 (M2), include region (north center, south center, south, west, and east), household net worth at baseline, mother’s years of education, father’s years of education, mother’s age at respondent’s birth, mother’s age at first birth, family structure (two parent family, single parent family, other family structure), parenting style (uninvolved, permissive, authoritarian, authoritative), parental monitoring level (score range of 0–16, with higher scores indicating greater parental monitoring), and urban status at baseline. Control variables were all collected at Wave I. Multiple imputation is used to adjust for missing data and longitudinal weights are used.

2.1. Analytic strategy

In this study I apply linear probability regression models using three comparison groups. To develop the alternative comparison groups, I use the answers to the stressful experience series of questions. The first alternative comparison group is youth who experienced other forms of stress. If youth responded that they had experienced a death, parental divorce, family member extended hospitalization, violent crime victimization, homelessness, or the extended unemployment of a household member between 1997 and 2007 they are categorized as having experienced another form of stress. The second alternative comparison group is youth who experienced other forms of household or familial absence. If youth responded that they experienced a death, parental divorce, or family member extended hospitalization between 1997 and 2007 they are categorized as having experienced another form of absence.

The results presented employ linear probability regression models. Results were also estimated using logistic regression analyses and the significance pattern and direction of associations were similar. The linear regression results are presented here because the coefficients will be compared across models. First, the traditional comparison regression is used to estimate the association between household member incarceration and the outcomes, comparing those who have experienced household member incarceration to those that did not. I also use this model specification to estimate the probability of experiencing the outcomes by household member incarceration status. Next, the other stress model is used to estimate the association between household member incarceration and the outcomes, comparing those who experienced household member incarceration to those that experienced another form of stress in the household (death, divorce, hospitalization, violent crime victimization, homelessness, or unemployment). Last, the other familial absence model is used to estimate the association between household member incarceration and the outcomes, comparing those who experienced household member incarceration to those who experienced another form of absence in the household (death, divorce, or hospitalization).

3. Results

Six percent of the sample experienced household member incarceration, as seen in Table 1. Descriptive analyses (not shown) find that those who experienced household member incarceration had a higher prevalence of risky sexual health behaviors. Four percent of those who experienced household member incarceration reported having sexual intercourse with an IV drug user compared to two percent of those who did not. Similarly, higher percentages of those who experienced household member incarceration reported sexual intercourse with a stranger (26% compared to 21%) and having had more than ten sexual partners (5% compared to 3%). Last, those who reported household member incarceration had lower condom use in adulthood than those who did not (25% compared to 28%).

Table 1.

Descriptive statistics for the analytic sample.

Mean/Prop Std. Dev.
Outcomes
   Sex with Stranger 0.19
   Sex with IV Drug User 0.02
   Sex with 10+ Partners 0.03
   Prop. of time used condom 0.26
Comparative Groups
   Household Incarceration 0.06
   Household Stress 0.41
   Household Absence 0.30
Demographics
   Male 0.51
   Age 14.32 1.48
   Citizenship 0.90
   Race/Ethnicity
      NH White 0.71
      NH Black 0.15
      Hispanic 0.13
      NH Other 0.01
   Prior Arrest 0.08
Family/Context
   Household Net Worth 111436.50 137436.20
   Father’s Years of School 12.97 3.23
   Mother’s Years of School 12.89 2.96
   Mom’s Age at First Birth 23.21 4.82
   Mom’s Age at R’s Birth 25.73 5.44
   Household Type
   Two Parent 0.55
   One Parent 0.39
   Other Family Structure 0.06
   Parenting Style
     Uninvolved 0.11
     Permissive 0.36
     Authoritarian 0.12
     Authoritative 0.41
   Parental Monitoring 9.13 3.42
   Region
     North East 0.19
     North Central 0.26
     South 0.34
     West 0.21
   Urban 0.72
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Notes. N = 7,332.

Prop is proportion, NH is non-Hispanic, R is respondent, Std. is standard, Dev. is deviation.

The inferential analyses, seen in Table 2, adjust for individual and family characteristics In Model 1 (M1), household member incarceration is associated with a 2 percentage-point higher probability of reporting sexual intercourse with an IV drug user compared to those who have not experienced household member incarceration, net of individual level covariates. When also controlling for family covariates in Model 2 (M2), this relationship is marginally significant. Household member incarceration is not significantly related to the probability of reporting sexual intercourse with a stranger using the traditional comparison group in M1 or M2. Household member incarceration associated with a two percentage-point higher probability of reporting more than 10 sexual partners with marginal significance when controlling for individual characteristics (M1) and family context (M2). Last, when using the traditional comparison group household member incarceration is significantly associated with a 5 percentage-point lower use of condoms in M1. Yet, when controlling for family characteristics in M2 this association is not significant.

Table 2.

Association between household member incarceration and risky sexual health behaviors with three comparison groups.

Sex with IV Drug User Sex with a Stranger Sex with 10+ Prop of Used Condom
Coefficient for HH Jail C.I. Coefficient for HH Jail C.I. Coefficient for HH Jail C.I. Coefficient for HH Jail C.I.
Traditional Comparison
  M1: + Individual Controls 0.02* (0.01) (0.00, 0.04) 0.03 (0.02) (−0.00, 0.08) 0.02+ (0.01) (−0.00, 0.04) −0.05* (0.02) (−0.09, −0.01)
  M2: + Family Controls 0.02+ (0.01) (−0.00, 0.04) 0.03 (0.02) (−0.02, 0.07) 0.02+ (0.01) (−0.00, 0.04) −0.03 (0.02) (−0.07, 0.01)
  N 7,693 7,693 7,693 6,575
Stress Comparison
  M1: + Individual Controls 0.02+ (0.01) (−0.00, 0.04) 0.01 (0.02) (−0.04, 0.05) 0.01 (0.01) (−0.01, 0.03) −0.04+ (0.02) (−0.08, 0.00)
  M2: + Family Controls 0.02 (0.01) (−0.00, 0.04) 0.14 (0.02) (−0.05, 0.04) 0.02 (0.01) (−0.01, 0.04) −0.02 (0.02) (−0.06, 0.02)
  N 3,145 3,145 3,145 2,697
Absence Comparison
  M1: + Individual Controls 0.02* (0.01) (0.00, 0.04) 0.03 (0.02) (−0.02, 0.07) 0.01 (0.01) (−0.01, 0.03) −0.05* (0.02) (−0.09, −0.00)
  M2: + Family Controls 0.02+ (0.01) (−0.00, 0.04) 0.01 (0.02) (−0.04, 0.06) 0.02 (0.01) (−0.01, 0.04) −0.02 (0.02) (−0.06, 0.03)
  N 2,326 2,326 2,326 2,001
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Notes. Individual controls include age, gender, race, citizenship, and prior arrests. Family controls include net worth at baseline, mother’s years of education, father’s years of education, mother’s age at respondent’s birth, mother’s age at first birth, parenting style, parental monitoring level, family structure, region, and urban status at baseline. Coefficient for household jail incarceration with standard error in parenthesis. M1 is Model 1, M2 is Model 2, Prop is proportion, and C.I. is confidence interval.

***

p < 0.000

**

p < 0.01

*

p < 0.05

+

p < 0.10.

Household member incarceration is largely not significantly related to sexual health behaviors when using the stress comparison group, as seen in Table 2. Household member incarceration is moderately association with the probability of reporting sexual intercourse with an IV drug user and condom use using the specification of M1 and the relationships are not significant when controlling for family context as seen in M2. There is no significant relationship between household member incarceration and the reporting sexual intercourse with a stranger or more than 10 partners with either model specification.

When using the absence comparison group, household member incarceration is again significantly associated with the probability of reporting sexual intercourse with an IV drug user in M1 and moderately so in M2, similar to the traditional comparison group. Interestingly, even the coefficient values are the same. Household member incarceration is not significantly associated with the probability of reporting sexual intercourse with a stranger or more than 10 partners in either model specification. Last, household member incarceration is significantly associated with lower condom use in M1 but not significantly associated with condom use in M2.

Using the M2 specification of the traditional comparison group in Table 2, the estimated probabilities of the outcomes by household member incarceration group are presented in Fig. 1. The estimated probabilities of reporting sexual intercourse with an IV drug user, sexual intercourse with a stranger, and reporting more than 10 sexual partners were all significantly higher for those who experienced household member incarceration (p < 0.000). The estimated proportion of the time that the respondent used a condom in the last year is significantly lower for those who reported household member incarceration (p < 0.000). Taken together, those who experience household member incarceration are expected to have riskier sexual health behaviors. Household member incarceration has a unique association with the risk of having sexual intercourse with an IV drug user but does not have a unique association with the risk of having sexual intercourse with a stranger, with 10 or more partners, or with condom usage although the estimated probabilities are quite high.

Fig. 1.

Fig. 1.

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Estimated probabilities of reporting sexual intercourse with an IV drug user, sexual intercourse with a stranger, sexual intercourse with 10 or more partners, and condom use by household member jail incarceration. Notes. Data from NLSY 97. IV is intravenous drug. Estimates based on traditional comparison group including controls for demographics and family context (M2) of Table 2. ***p < 0.000 and refers to a test between the predicted probability for the outcome between the household incarceration and no household incarceration groups.

4. Discussion

This study offers four primary contributions, which can inform both the literature examining the causes of risky sexual health among young adults and the literature examining the broader social consequences of incarceration. First, results indicate that young adults who experience household member incarceration engage more in risky sexual health behaviors, specifically having sexual intercourse with an IV drug user, having sexual intercourse with a stranger, having more than 10 sexual partners, and using a condom a lower proportion of the time. The inferential analyses do not find that household member incarceration is independently associated with every outcome; however, viewing this inequality in its context reveals that those who experience household member incarceration have, on average, riskier sexual health behaviors. Future research would benefit from taking a life course approach to determine the pathways behind these increased risks, with particular focus on the timing and structure of fertility as well as transitions between relationships including the timing of marriage.

It is important to note that youth that experience household member incarceration have riskier sexual health behaviors into adulthood because families experiencing household member incarceration tend to face additional risk in multiple domains of vulnerability. Families which experience incarceration are more likely to have inadequate access to health care, reside in low-resource neighborhoods, and attend schools that are lower income (Clear, 2007; Comfort, 2008; Turney, 2017), all of which present additional barriers to accessing regular and emergency contraception (Cullhane and Elo, 2005; Kirby and Kaneda, 2005). Children in homes that experience incarceration should be targeted for increased education about sexual health and access to free or low-cost reproductive healthcare. Moreover, the disproportionality by race and ethnicity in the risk of experiencing household member incarceration (Enns et al., 2019; Wildeman, 2009) underscores how incarceration, as a form of structural racism, may impact the reproductive health of youth and have potential downstream consequences for health inequity.

Second, household member incarceration is associated with a higher risk of reporting sexual intercourse with an IV drug user, even when compared to individuals who experienced other familial absence unrelated to incarceration. It is important to note that sexual intercourse with an IV drug user is a low prevalence event (see Supplemental Materials for a count of individuals across groups). The association is marginally significant using the absence comparison group, but the coefficient value remains the same across models. This finding identifies household member incarceration as a unique and direct source of risk for at least one sexual health behavior which is not explained by the stress and absence that household member incarceration causes. Having sexual intercourse with an IV drug user poses a considerable health risk which has implications for population health (HIV infection, risk, prevention, and testing behaviors among persons who inject drugs—national HIV behavioral surveillance: injection drug use, 20 U.S. cities, 2015, 2018). Approximately one third of HIV transmission in the US is attributable to IV drug use, and although it is difficult to disentangle the role of direct transmission through drug use versus indirect transmission through unsafe sexual intercourse it is clear that sexual intercourse with an IV drug user is a high risk behavior with potentially serious implications for health (Celentano et al., 2008).

To address the risks associated with household member incarceration, alternatives to incarceration that allow family members to remain in their homes, as well as increased supports during community reentry represent possible avenues for reducing the burdens of incarceration on household members. A review of research examining contact between children and incarcerated parents by Poehlmann et al. (2010) found that, with a few exceptions, contact was beneficial for children’s adjustment and development. Future research should also examine if sustained contact between children and incarcerated parents mitigates the association between familial incarceration and risk sexual health behaviors, especially given the importance of family relationships for sexual health behaviors (Jiskrova and Vazsonyi, 2019; Miller et al., 2001).

Future research should also explore other potential pathways behind the effect of household member incarceration on the risk of having sexual intercourse with an IV drug user, in order to design interventions to mitigate this risk. Additionally, research examining risk among families and children should include household member incarceration. Public health practitioners should also target individuals who have experienced household member incarceration for sexual health education services and increase access for reproductive healthcare. Preference for needle-exchange locations and safe injection zones should be given to high incarceration neighborhoods to help reduce the health risks associated with having sexual intercourse with an IV drug user.

Third, I find that the initial association between household member incarceration and lower condom usage is significant in M1 for each comparison group yet not in M2 when family context control variables are introduced. While this study does not provide evidence that household member incarceration is associated with condom use net of household characteristics, it does find that youth who experience household member incarceration use condoms at a lower rate. Condom use is especially important, given that it provides protection against the risk of unintended pregnancy and the transmission of sexually transmitted infections (STI) in the context of other risky sexual health behaviors. For example, one study found that more than a quarter of IV drug users with HIV-positive status reported unprotected sexual intercourse (Celentano et al., 2008). Given that household member incarceration is positively associated with having sexual intercourse with an IV drug user, promoting condom use among young who experience household member incarceration could protect their health.

Last, the estimation of the association between household member incarceration and risky sexual health behaviors largely did not change with the use of alternative comparison groups. The sole exception is related to the stress comparison group, where the results are marginally significant in the traditional and absence comparison groups, but not with the stress comparison group for having sexual intercourse with an IV drug user and condom use. It is possible that the association between household member incarceration and the risk of having sexual intercourse with an IV drug user is partially attributable to the stress of household member incarceration. However, these results are marginally significant and the coefficient value remains the same, complicating the interpretation. However, when examining the association between household member incarceration and condom use a similar pattern emerges—M1 is significant using the traditional comparison group and the absence comparison group but only marginally significant using the stress comparison group. This again suggests that the positive association between household member incarceration and the risky sexual health behaviors of having sexual intercourse with an IV drug user and the negative association with condom use may be, in part, attributable to the well documented stress that accompanies household member incarceration.

The results did not confirm the hypothesis that the association between household member incarceration and some sexual health behaviors may be attributable to the absence of the household member. While absence is thought to be causal pathways behind the effects of parental incarceration, it is possible that there are different pathways which link household member incarceration to deleterious outcomes for youth. For example, children spend considerably more time with and are more reliant on parents than other family members and may therefore be less affected by the absence of a household member incarceration than for parental incarceration. Future research should seek to clarify the causal mechanisms behind household member incarceration specifically and pursue research related to household member incarceration as a unique risk to families and children.

Another well identified mechanism linking parental incarceration to child outcomes is stigma, yet this study was unable to test this pathway. Future research should explore the role of stigma in sexual health behaviors using alternative methods which are better suited to exploring the role of stigma (for example experimental methodologies due to their ability to capture implicit biases or qualitative research which can probe perceived stigma). Alternatively, it is possible that part of these associations is in fact attributable to stress and absence, this design as just unable to capture these associations. Either way, in this study I found limited evidence that the effects of household member incarceration on sexual health behaviors through early adulthood are accounted by the absence of a household member. However, there were differences between M1 and M2 and a pattern of limited significance using the stress comparison group, indicating that the risk associated with household member incarceration may be accounted for by the characteristics of families and/or the stress that accompanies household member incarceration.

4.1. Limitations

Although this study provides novel contributions to the literature, it should be viewed in light of its limitations. This study attempts to untangle the effect of household member incarceration from household stress and household member absence; however, issues of selection and unobserved heterogeneity remain. The models used in this study only adjust for observed characteristics, and it is possible that unobserved differences between those who experience household member incarceration and those who do not may complicate these associations. Additionally, due to data limitations these models do not adjust for key concepts in the stress process model, such as self-concept. This project also relies on self-reported data on sensitive topics, such as sexual behaviors and the incarceration of a loved one. Social desirability bias may have affected participant responses.

This study also does not take into account the duration, frequency, or type of household member incarceration due to data limitations. Nor does it account for the frequency of contact between the respondent and the incarcerated household member. These characteristics of household member incarceration and contact are likely to shape the impact of household member incarceration on sexual health behaviors. Future research should collect on the frequency and duration of incarceration to support the novel exploration of how these specific facets of incarceration may shape sexual health behaviors.

5. Conclusion

Household member incarceration poses a unique threat to sexual health and is an often-overlooked stressor for families and children. Future research should explore the implications of this unique risk to sexual health, including the population level implications for infectious disease spread and later life health disparities. This is especially important in light of the disproportionately in the risk of experience household member incarceration. Incarceration is a form of structure racism which presents a threat to the sexual health behaviors those who experienced household member incarceration during adolescence. Additionally, the increased stress faced by families experiencing incarceration play a notable role in the detrimental effects of household member incarceration on risky sexual health behaviors. Research and policy reforms aimed at decreasing the health risks for individuals associated with familial incarceration and stemming the intergenerational consequences of incarceration on population health and racial disparities in health should include supporting alternatives to incarceration which keep convicted family members within the home.

Supplementary Material

Supplementary Table 1

Acknowledgements

This paper and the research behind it would not have been possible without the support and encouragement of my advisor, Christopher Wildeman. I would like to acknowledge the diligent proofreading of Devin McCauley. You have saved me from many errors; those that inevitably remain are entirely my own. I am also grateful for the feedback I received on a presentation of this work from the LifeSpan/Brown Criminal Justice Research Training Program on Substance Use and HIV (Funded by the National Institute on Drug Abuse R25DA037190), in which I am a trainee.

Footnotes

Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.socscimed.2021.113718.

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Supplementary Materials

Supplementary Table 1
NIHMS1748807-supplement-Supplementary_Table_1.docx (14.1KB, docx)

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