Jama Network-Incarceration of Youths in Adult Correctional Facility and Risk of Premature Death, July 2023
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JAMAIOpen,. Network Original Investigation | Public Health Incarceration of Youths in an Adult Correctional Facility and Risk of Premature Death Ian A. Silver, PhD; Daniel C. Semenza, PhD; Joseph L. Nedelec, PhD Abstract IMPORTANCE Youths incarcerated in adult correctional facilities are exposed to a variety of adverse circumstances that could diminish psychological and physical health, potentially leading to early mortality. Key Points Question Is incarceration of youths in adult correctional facilities associated with an increased risk of mortality through 39 years of age? OBJECTIVE To evaluate whether being incarcerated in an adult correctional facility as a youth was Findings In this cohort study of 8951 associated with mortality between 18 and 39 years of age. youths, incarceration in an adult correctional facility before the age of 18 DESIGN, SETTING, AND PARTICIPANTS This cohort study relied on longitudinal data collected years was associated with a 33% from 1997 to 2019 as part of the National Longitudinal Survey of Youth–1997, a nationally increase in the risk of mortality between representative sample of 8984 individuals born in the United States between January 1, 1980, and 18 and 39 years of age. December 1, 1984. The data analyzed for the current study were derived from annual interviews between 1997 and 2011 and interviews every other year from 2013 to 2019 (19 interviews in total). Participants were limited to respondents aged 17 years or younger during the 1997 interview and alive during their 18th birthday (8951 individuals; >99% of the original sample). Statistical analysis was performed from November 2022 to May 2023. Meaning This study suggests that incarceration in an adult correctional facility as a youth was associated with early mortality, potentially through diminished psychological and physical health. INTERVENTION Incarceration in an adult correctional facility before the age of 18 years compared with being arrested before the age of 18 years or never arrested or incarcerated before the age of 18 years. MAIN OUTCOMES AND MEASURES The main outcome for the study was age at mortality between 18 and 39 years of age. + Invited Commentary + Supplemental content Author affiliations and article information are listed at the end of this article. RESULTS The sample of 8951 individuals included 4582 male participants (51%), 61 American Indian or Alaska Native participants (1%), 157 Asian participants (2%), 2438 Black participants (27%), 1895 Hispanic participants (21%), 1065 participants of other race (12%), and 5233 White participants (59%). A total of 225 participants (3%) died during the study period, with a mean (SD) age at death of 27.7 (5.9) years. Incarceration in an adult correctional facility before the age of 18 years was associated with an increased risk of earlier mortality between 18 and 39 years of age compared with individuals who were never arrested or incarcerated before the age of 18 years (time ratio, 0.67; 95% CI, 0.47-0.95). Being arrested before the age of 18 years was associated with an increased risk of earlier mortality between 18 and 39 years of age when compared with individuals who were never arrested or incarcerated before the age of 18 years (time ratio, 0.82; 95% CI, 0.73-0.93). CONCLUSIONS AND RELEVANCE In this cohort study of 8951 youths, the survival model suggested that being incarcerated in an adult correctional facility may be associated with an increased risk of early mortality between 18 and 39 years of age. JAMA Network Open. 2023;6(7):e2321805. Last corrected on July 24, 2023. doi:10.1001/jamanetworkopen.2023.21805 Open Access. This is an open access article distributed under the terms of the CC-BY License. JAMA Network Open. 2023;6(7):e2321805. doi:10.1001/jamanetworkopen.2023.21805 (Reprinted) Downloaded From: https://jamanetwork.com/ on 08/02/2023 July 5, 2023 1/10 Downloaded From: https://jamanetwork.com/ on 08/02/2023 JAMA Network Open. 2023;6(7):e2321805. doi:10.1001/jamanetworkopen.2023.21805 (Reprinted) The approval for the data collection was obtained by the institutional review boards at The Ohio approval as the study relied on publicly available deidentified data that can be retrieved by anyone. reporting on a secondary publicly available cohort study. We did not seek institutional review board (STROBE) reporting guideline for reporting by satisfying all the applicable items (1-21) in terms of The current study follows the Strengthening the Reporting of Observational Studies in Epidemiology Analytical Sample Methods via arrests, associated risk factors, and demographic differences. with greater risk for early mortality after accounting for broader exposure to the criminal legal system We hypothesize that juvenile incarceration in an adult correctional facility will be associated with early mortality after release for those who have been incarcerated as a youth in an adult facility. victimization, and higher engagement in risky behaviors, such as substance abuse, may be associated and developmental processes. Poorer mental and physical health, greater risk for violence and youths as a result of more harmful exposures in prison and disruption to key social, psychological, developmental periods.23 Incarceration among adults is likely to have damaging iatrogenic effects for and violence, which can lead to further isolation and loss of socialization during critical facilities often struggle to adjust to prison life and display heightened rates of disciplinary misconduct environments, exposing them to greater risk for sexual and physical assault.18,21,22 Youths in adult Youths incarcerated in adult facilities are more likely to engage with antisocial adult peers in prison Young people housed in adult correctional facilities report being more afraid for their safety.14 were associated with early mortality among a sample of youths in Indiana.12 to the present study, researchers have observed that detention in jail and transfer to adult court more distress and higher rates of psychiatric symptoms than those in juvenile centers.18 Most salient depression compared with those in juvenile facilities.18-20 In Texas, youths in adult facilities reported incarcerated in adult facilities report substantially greater rates of posttraumatic stress disorder and documents serious extralegal consequences for youths incarcerated in adult facilities. Youths of formally processed juvenile delinquency cases are transferred to an adult criminal court,17 research place less emphasis on treatment, counseling, and education.16 Even though only approximately 1% different experiences. Adult facilities are often much larger, have higher resident to staff ratios, and in adult prison facilities.14,15 Incarceration in juvenile vs adult correctional facilities represents vastly In most US states, youths can be transferred and sentenced in adult court, resulting in detention early death.13 reproductive health, risk-taking behaviors, and mental well-being that heighten the likelihood of severe.12 Youths who are incarcerated experience health challenges related to dental care, sexual and nonincarcerated youths as involvement in the criminal legal system becomes more protracted and violence and homicide victimization.6 Incarcerated youths face greater risk for early death than nonincarcerated Medicaid-enrolled youths of the same age, associated largely with exposure to a history of incarceration have an all-cause mortality rate roughly 5.9 times higher than observed in mortality specifically among youths, legally defined as children younger than 18 years.11 Youths with A smaller body of research documents the association of incarceration exposure with early infectious disease.9,10 victimization and homicide,6 substance use and overdose,7,8 and higher incidence of chronic and have been shown to link incarceration to early mortality, including greater risk for violent or roughly 13% of the average US life expectancy at the age of 45 years.5 Numerous mechanisms Mortality excesses associated with incarceration translate to losses of life expectancy of 4 to 5 years, association such that more time served in prison corresponds to greater reductions in life span.4 July 5, 2023 2/10 Incarceration of Youths in an Adult Correctional Facility and Risk of Premature Death Incarceration exposure is associated with early mortality.1-3 Research documents a dose-response Introduction JAMA Network Open | Public Health c..G Downloaded From: https://jamanetwork.com/ on 08/02/2023 JAMA Network Open. 2023;6(7):e2321805. doi:10.1001/jamanetworkopen.2023.21805 (Reprinted) in the survival model.27,28 These covariates include items measuring the self-rated general health of known to be associated with contact with the criminal legal system and early mortality were included formed, directed acyclic graph (eAppendix 1 and eFigure in Supplement 1).1,10,12,13 Four covariates confounders—and exclude mediators—following the development of a theoretically and empirically Study variables were selected to limit the potential bias associated with colliders and Control Variables: General Risk Factors and Demographic Characteristics facility (jail or prison) and the number of months spent in an adult correctional facility.26 the current study capture data on whether an adolescent was incarcerated in an adult correctional the monthly arrays for incarceration created by the NLSY97 research team. The measures created for intoxication, pretrial detention, and confinement in juvenile detention centers were excluded from offenses (eg, truancy), holds for DUI (driving under the influence of alcohol or drugs), holds for public respondent experienced before the age of 18 years. Periods of confinement associated with status created to measure the number of arrests and the number of months incarcerated that each arrested or incarcerated before the age of 18 years (0 = no; 1 = yes). Two continuous variables were the age of the respondent each year, 2 variables were created to measure whether a respondent was or more days in the correctional facility during that month. With the use of the monthly arrays and NLSY97 research team considered an individual incarcerated during a specified month if they spent 1 any point during a specified month from 1992 to 2019. Due to concerns associated with privacy, the identifying the number of arrests a respondent experienced and if a respondent was incarcerated at incarceration period since their last interview. The NLSY97 research team developed monthly arrays The respondents were requested to report the date of each arrest and the start and end date for each Key Independent Variables: Arrest and Incarceration in Adult Correctional Facilities recorded in the age at death measure for individuals who did not die between 18 and 39 years of age. Consistent with the implementation of a survival analysis, the age at the final interview was also and confirm death records for all respondents using official data sources from state agencies. the year they died, as reported by family members or friends. The NLSY97 research team did request the US Social Security Office.25 Second, a respondent’s age at death was recorded as their age during years of age. The mortality rate observed in the NLSY97 is consistent with the estimates produced by (0 = no; 1 = yes). Of the 8951 individuals included in the sample, 225 (3%) died between 18 and 39 First, a variable for death was created to indicate if a respondent died between 18 and 39 years of age nonresponse tracking for the NLSY97. With the use of this information, 2 variables were created. Respondents who did not complete an interview because they died were identified as part of the Dependent Variables: Death and Age at Death Measures any respondents. sample). Because the study uses publicly available deidentified data, consent was not obtained from during the 1997 interview and alive during their 18th birthday (8951 individuals; >99% of the original to the respondent. The analytical sample included respondents who were 17 years of age or younger the interview, the interview was completed in person in a visitation room or via telephone at no cost and from 34 to 39 years during the 2019 interview. If a respondent was incarcerated at the time of been completed, with the respondents ranging in age from 12 to 18 years during the 1997 interview from 1997 to 2011 and in interviews every 2 years from 2013 to 2019. In total, 19 interviews have 1, 1980, and December 1, 1984.24 The 8984 respondents agreed to participate in yearly interviews NLSY97, a nationally representative sample of individuals born in the United States between January Labor Statistics. The data for the current study are derived from the publicly available version of the National Longitudinal Study of Youth–1997 (NLSY97) is provided on the website of the US Bureau of research team, with which we have no affiliation. All data documentation associated with the July 5, 2023 3/10 Incarceration of Youths in an Adult Correctional Facility and Risk of Premature Death State University and National Opinion Research Center at the University of Chicago by the NLSY97 JAMA Network Open | Public Health c..G Downloaded From: https://jamanetwork.com/ on 08/02/2023 JAMA Network Open. 2023;6(7):e2321805. doi:10.1001/jamanetworkopen.2023.21805 (Reprinted) incarcerated for up to 3.5 years in an adult facility. youths in an adult correctional facility. Some youths experienced as many as 17 arrests and were sample were arrested before the age of 18 years, while 109 respondents (1%) were incarcerated as mean (SD) age at death of 27.7 (5.9) years. A total of 1597 of the respondents (18%) in the analytical participants (59%) (Table 1). A total of 225 respondents (3%) died during the study period, with a Hispanic participants (ethnicity; 21%), 1065 participants of other race (12%), and 5233 White or Alaska Native participants (1%), 157 Asian participants (2%), 2438 Black participants (27%), 1895 The analytical sample of 8951 individuals included 4582 male participants (51%), 61 American Indian Results analyses is provided in eAppendix 4 in Supplement 1. 4.2.3.36 To maintain open science, the R script used to clean the data and estimate all of the statistical P < .05. All analyses were estimated using the survival35 and the SurvMetrics packages in R, version results. All P values were from 2-sided tests and results were deemed statistically significant at cumulative probability of death was calculated and plotted to permit a visual evaluation of the death. The TR is calculated as the exponentiated value of the slope coefficient (exp [b]). The than 1 indicate an increased odds of survival and values lower than 1 indicate an increased risk of time ratio (TR) represents the risk of an event occurring across all time periods, where values higher proportional hazard assumption of a Cox proportional hazards regression survival model.32-34 The association between the independent variables and the dependent variable did not satisfy the compared. A parametric survival model was preferred for the current analysis because the Weibull, gaussian, logistic, and loglogistic—and the resulting Akaike information criteria were intercept-only model was estimated with each distributional specification—lognormal, exponential, was estimated using a lognormal distribution given the distributional properties of age at death. An independent and control variables using a parametric survival model. The parametric survival model descriptive statistics were produced. Third, death status and the age at death were regressed on the arrests, the number of months incarcerated, or the death status of the respondents. Second, version 4.2.3 [R Project for Statistical Computing]).31 No information was missing on the number of data sets with 10 iterations each (pulled using the complete function from the mice package in R, eTable 2 in Supplement 1).31 The imputed values for the covariates represent the first of 5 imputed constructs) was implemented to impute missing values on the covariates (eAppendix 2, eTable 1, and random forest method (continuous constructs) and the logistic regression method (dichotomous was implemented. First, a missing data analysis was conducted, and multiple imputation using the Statistical analysis was performed from November 2022 to May 2023. A 4-part analytical strategy Statistical Analysis to adjust for possible differences in the sampling procedures.24 respondent participated (0 = initial sample; 1 = supplemental sample) was also included in the model Hispanic]). A dichotomous indicator (supplemental sample) for the NLSY97 sample in which the individuals of multiple races and individuals who did not identify a race after initially identifying as (American Indian or Alaska Native, Asian, Black, White; reference was other race [including male sex (reference = female sex), ethnicity (Hispanic; reference = non-Hispanic), and race In addition to these risk factors, demographic characteristics were adjusted for the inclusion of 18 years. housing) before the age of 18 years, and the respondent’s household net worth before the age of experienced homelessness, lived in a place without water or electricity, or resided in emergency respondent turned 16 years of age, whether the respondent experienced childhood adversity (eg, measured in 1997),29,30 whether 1 or both of the respondent’s parents were incarcerated before the July 5, 2023 4/10 Incarceration of Youths in an Adult Correctional Facility and Risk of Premature Death the respondent before the age of 18 years (0 = poor; 1 = fair; 2 = good; 3 = very good; 4 = excellent; JAMA Network Open | Public Health c..G 623 (7) 489 (5) NA Childhood adversity Household net worth before the age of 18 y, $ 4369 (49) Female 7056 (79) Non-Hispanic 2438 (27) 1065 (12) 5233 (58) Black Othera White 0.25 (0.43) 0.58 (0.49) 0.12 (0.32) 0.27 (0.45) 0.02 (0.13) 0.006 (0.08) 0.79 (0.41) 0.21 (0.41) 0.49 (0.50) 0.51 (0.50) 92 288 (139 363) 0.05 (0.23) 0.07 (0.25) 3.06 (0.91) 0.38 (1.19) 0.17 (0.37) 0.08 (1.12) 0.01 (0.11) 27.7 (5.9) 0.03 (0.16) Mean (SD) Downloaded From: https://jamanetwork.com/ on 08/02/2023 JAMA Network Open. 2023;6(7):e2321805. doi:10.1001/jamanetworkopen.2023.21805 (Reprinted) 2230 (25) 157 (2) Asian Supplemental sample 61 (1) American Indian or Alaska Native Race 1895 (21) Hispanic Ethnicity 4582 (51) Male Sex Demographics NA Parental incarceration before age 16 y NA 1597 (18) NA 109 (1) NA 225 (3) No. (%) (N = 8951) Self-rated health before age 18 y General risk factors No. of arrests Arrested No. of months incarcerated in adult facility Incarcerated in adult facility Key independent variables (before age 18 y) Age at death, y Death Key dependent variable (aged 18-39 y) Characteristic Table 1. Descriptive Statistics for the Analytical Sample (N = 8951) 0 to 1 0 to 1 0 to 1 0 to 1 0 to 1 0 to 1 0 to 1 0 to 1 0 to 1 0 to 1 −935 251 to 600 000 0 to 1 0 to 1 0 to 4 0 to 17 0 to 1 0 to 42 0 to 1 18 to 39 0 to 1 Range accounting for time served in a juvenile facility. The association between incarceration in an adult (eAppendix 3, eTable 3, and eTable 4 in Supplement 1) assessed whether the findings held after associated with an increased risk of death between 18 and 39 years of age. Supplemental analyses legal system as a youth—both arrest and, especially, incarceration in adult correctional facilities—was estimated to have died by the age of 39 years. Overall, the findings suggest that contact with the years of age and just over 2% of youths without legal system contact before the age of 18 years were estimated to die by the age of 39 years. In comparison, just over 5% of youths arrested before 18 shown in the Figure, approximately 8% of youths incarcerated in adult correctional facilities were facilities, arrested youths, and respondents without legal system contact before 18 years of age. As We plotted the cumulative probability of death for youths incarcerated in adult correctional associated with a higher risk of early death (TR, 0.84; 95% CI, 0.77-0.91). associated with a higher likelihood of survival (TR, 1.10; 95% CI, 1.05-1.15), while being male was with the risk of death prior to 39 years of age. Better general health before 18 years of age was (TR, 1.02; 95% CI, 0.99-1.06) nor the number of arrests (TR, 1.00; 95% CI, 0.97-1.04) were associated compared with not being arrested. Neither the number of months of incarceration in an adult facility associated with an increase in the risk of death until the age of 39 years (TR, 0.82; 95% CI, 0.73-0.93) compared with nonincarcerated youths. In addition, being arrested before the age of 18 years was associated with an approximate 33% increase in the risk of death (TR, 0.67; 95% CI, 0.47-0.95) death before the age of 39 years. Incarceration of youths in an adult correctional facility was a July 5, 2023 5/10 Includes individuals of multiple races and individuals who did not identify a race after initially identifying as Hispanic. Abbreviation: NA, not applicable. Incarceration of Youths in an Adult Correctional Facility and Risk of Premature Death Table 2 provides the results of the parametric survival model that assessed the likelihood of JAMA Network Open | Public Health c..G 1.00 (0.97 to 1.04) −0.20 (0.06) [−0.32 to −0.07] 0.00 (0.02) [−0.03 to 0.04] Arrestedb −0.17 (0.07) [−0.31 to −0.04] 0.00 (0.09) [−0.17 to 0.17] 0.00 (0.00) [0.00 to 0.00] Parental incarceration before 16 yb Childhood adversity Household net worth before 18 yb 0.27 (0.28) [−0.28 to 0.81] −0.16 (0.10) [−0.36 to 0.04] 0.08 (0.07) [−0.06 to 0.22] −0.07 (0.10) [−0.25 to 0.12] 0.05 (0.06) [−0.06 to 0.16] Asian (reference: other) Black (reference: other) Hispanic (reference: non-Hispanic) White (reference: other) Supplemental sample 0.723 Scale NA 18 21 24 27 Age, y 30 33 36 No CLS contact Arrested <18 y Incarcerated <18 y Downloaded From: https://jamanetwork.com/ on 08/02/2023 JAMA Network Open. 2023;6(7):e2321805. doi:10.1001/jamanetworkopen.2023.21805 (Reprinted) 0 0.02 0.04 0.06 0.08 0.10 0.12 39 1.05 (0.94 to 1.17) 0.94 (0.78 to 1.13) 1.08 (0.94 to 1.25) 0.85 (0.70 to 1.04) 1.31 (0.76 to 2.26) 1.02 (0.56 to 1.84) 0.84 (0.77 to 0.91) 1.00 (1.00 to 1.00) 1.00 (0.84 to 1.18) 0.84 (0.74 to 0.96) 1.10 (1.05 to 1.15) Figure. Cumulative Probability of Dying by Age for Varying Types of Contact With the Legal System 8951 −1737.1 Intercept only log likelihood No. −1684.7 Model log likelihood −0.32 (0.05) [NA] 0.02 (0.30) [−0.57 to 0.61] American Indian or Alaska Native (reference: other) Log (scale) −0.17 (0.04) [−0.26 to −0.09] Maleb Demographic characteristics 0.09 (0.02) [0.05 to 0.14] Self-rated healthb General risk factors No. of arrests 0.02 (0.02) [−0.01 to 0.06] 1.02 (0.99 to 1.06) 0.82 (0.73 to 0.93) −0.40 (0.18) [−0.75 to −0.05] 0.67 (0.47 to 0.95) Time ratio (95% CI) No. of months incarcerated in adult facility b (SE) [95% CI] Incarceration in adult facilityb Key independent variables (before age of 18 y) Dependent variable: age at death (18-39 y) Table 2. Parametric Survival Model Regressing Age at Death on Arrest as a Youth and Incarceration in an Adult Facility as a Youtha designed for the crucial developmental years of adolescence, where neuronal and social factors imprisoned in adult facilities. Youths incarcerated in adult facilities experience a system that is not exposure with health overall, a much smaller segment has focused on such associations for youths Although a relatively large body of literature highlights the detrimental associations of incarceration Discussion 0.47-0.95) (eTable 4 in Supplement 1). Cumulative probability of death Indicates P < .05. Following the Akaike information criterion, it was determined that the parametric survival model should be estimated using a lognormal distribution given the distributional properties of age at death. July 5, 2023 6/10 The cumulative probability of dying by the corresponding age was estimated using the results from the model presented in Table 2. Incarcerated <18 y indicates ever spending time in an adult correctional facility as a youth. CLS indicates criminal legal system. b a Abbreviation: NA, not applicable. Incarceration of Youths in an Adult Correctional Facility and Risk of Premature Death correctional facility and an increased risk of death remained virtually identical (TR, 0.67; 95% CI, JAMA Network Open | Public Health c..G Downloaded From: https://jamanetwork.com/ on 08/02/2023 JAMA Network Open. 2023;6(7):e2321805. doi:10.1001/jamanetworkopen.2023.21805 (Reprinted) born in the US between 1980 and 1984. Fifth, due to the existing literature and the measures years of age (n = 225), and the current study can be generalized only to the birth cohort of individuals does not identify the cause of death. Fourth, a limited number of individuals died between 18 and 39 associated with the increased likelihood of early death. Third, due to data limitations, the NLSY97 facilities among youths transferred to such prisons in the analytical sample is a potential factor mechanisms for the observed patterns. For example, heterogeneity in the experience of adult observed findings.40 Second, the data do not provide for a nuanced assessment of the potential aspects of the NLSY97 cohort used to form the analytical sample that were associated with the incarcerated in adult facilities, at least 5 limitations should temper the findings. First, there could be Although the current study illustrated an increased likelihood of early mortality for youths Limitations youths to adult facilities to avoid the potential lethality of such exposure. findings observed in the current study highlight the need for rethinking the practice of transferring association is causal or a function of the risk factors that youths bring with them (or both), the incarceration process may be amplified by experiences in adult correctional facilities. Whether the incarceration.38,39 Consequently, the mortality risk factors that youths bring with them to the health-related risk factors at much higher rates than youths who do not experience unrelated or tangentially related to the legal system. Youths who are incarcerated tend to possess Second, the observed association may not be causal but instead indicative of a process observed here. facility. Future research should further assess potential mechanisms of the association Thus, it is conceivable that the associations are exacerbated when experienced by youths in an adult These associations, however, were examined in prior literature using adult prisoners in adult facilities. (eg, increased risk for violent victimization, substance use, disease, and harmful behaviors).6,7,9 mechanisms are plausible that align with prior research on the detrimental effects of incarceration such as general health, being male, and early contact with the legal system. Several potential correctional facility as a youth may have an association with early mortality beyond other risk factors, Overall, these results point to a handful of potential explanations. First, any exposure to an adult eTable 3, and eTable 4 in Supplement 1). incarceration in juvenile correctional facilities was not associated with early mortality (eAppendix 3, adult correctional facilities could be associated with detrimental health outcomes because models further suggest that the circumstances to which youths are exposed during incarceration in facility as a youth evinced the highest risk for early mortality. The findings of the supplemental legal system was associated with an increased risk of premature death, being incarcerated in an adult those without contact with the legal system. Third, while it appears that any formal contact with the approximately 3 times higher for those who were incarcerated in an adult facility compared with where the proportion of youths who were estimated to die by the age of 39 years appeared to be an adult correctional facility and early mortality remained. This association is illustrated in the Figure, with health, family background, and socioeconomic status, yet the association between exposure to of exposure. Second, our multivariable models accounted for several general risk factors associated analytical sample were incarcerated in an adult facility, there was substantial variability in the length The analyses revealed 3 key findings. First, while a relatively small proportion of youths in the longitudinal, nationally representative sample of US youths. national sample, to our knowledge. The current study addressed this gap in the literature using a has examined the extent to which these experiences may be associated with premature death in a associated with a variety of detrimental outcomes related to well-being; however, to date, no study factors associated with the likelihood of early mortality. Experiences of incarceration have been youths may not only engage in risky and harmful behaviors37 but they may directly experience risk encounter a system intended exclusively for socially matured individuals. Within such a system, July 5, 2023 7/10 Incarceration of Youths in an Adult Correctional Facility and Risk of Premature Death interact to affect personality and behavioral outcomes across the life course.37 Instead, such youths JAMA Network Open | Public Health c..G Downloaded From: https://jamanetwork.com/ on 08/02/2023 JAMA Network Open. 2023;6(7):e2321805. doi:10.1001/jamanetworkopen.2023.21805 (Reprinted) 5. Daza S, Palloni A, Jones J. The consequences of incarceration for mortality in the United States. Demography. 2020;57(2):577-598. doi:10.1007/s13524-020-00869-5 4. Patterson EJ. The dose-response of time served in prison on mortality: New York State, 1989-2003. Am J Public Health. 2013;103(3):523-528. doi:10.2105/AJPH.2012.301148 3. Sykes BL, Chavez E, Strong J. Mass incarceration and inmate mortality in the United States—death by design? JAMA Netw Open. 2021;4(12):e2140349. doi:10.1001/jamanetworkopen.2021.40349 2. Massoglia M, Pare PP, Schnittker J, Gagnon A. The relationship between incarceration and premature adult mortality: gender specific evidence. Soc Sci Res. 2014;46:142-154. doi:10.1016/j.ssresearch.2014.03.002 REFERENCES 1. Bovell-Ammon BJ, Xuan Z, Paasche-Orlow MK, LaRochelle MR. Association of incarceration with mortality by race from a national longitudinal cohort study. JAMA Netw Open. 2021;4(12):e2133083. doi:10.1001/ jamanetworkopen.2021.33083 Data Sharing Statement: See Supplement 2. Conflict of Interest Disclosures: None reported. Statistical analysis: Silver, Nedelec. Critical revision of the manuscript for important intellectual content: All authors. Drafting of the manuscript: All authors. Acquisition, analysis, or interpretation of data: Silver, Nedelec. Concept and design: All authors. Author Contributions: Dr Silver had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Author Affiliations: Center for Legal Systems Research, RTI International, Research Triangle Park, North Carolina (Silver); Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey (Semenza); New Jersey Gun Violence Research Center, Department of Urban-Global Health, School of Public Health, Rutgers University, New Brunswick, New Jersey (Semenza); School of Criminal Justice, University of Cincinnati, Cincinnati, Ohio (Nedelec). Corresponding Author: Ian A. Silver, PhD, Center for Legal Systems Research, RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC 27709 (isilver@rti.org). Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2023 Silver IA et al. JAMA Network Open. Correction: This article was corrected on July 24, 2023, to fix an error in wording in the Methods section. Published: July 5, 2023. doi:10.1001/jamanetworkopen.2023.21805 ARTICLE INFORMATION Accepted for Publication: May 12, 2023. adult correctional facilities. factors to ameliorate the potential extralegal harm—including lethal impacts—of placing youths in pursuing rehabilitation in prison.9,10,18 Prevention and intervention efforts should be directed at the results emphasize the importance of considering the health-related needs of youths while increased risk of mortality further illustrates a need for reassessment of this practice. Furthermore, harmful. The observed association between youth imprisonment in adult correctional facilities and Our cohort study illustrates that incarcerating youths in adult correctional facilities is potentially very Conclusions available in the NLSY97. association of interest. 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Descriptive Statistics for the Analytical Sample Before Imputation (N = 8,951) eTable 2. Missing Case Comparison for Key Constructs Before Imputation (n = 8,951) eAppendix 3. Model Replications With Youth Incarcerated in Juvenile Facilities eTable 3. Parametric Survival Model Regressing Age at Death on Being Incarcerated in a Juvenile Facility eTable 4. Parametric Survival Model Regressing Age at Death on Being Incarcerated in a Juvenile Facility, Arrested as a Juvenile, and Incarcerated in an Adult Facility as a Juvenile eAppendix 4. R Script 40. Latzer B. The Rise and Fall of Violent Crime in America. Encounter Books; 2016. 39. Pyle N, Flower A, Fall AM, Williams J. Individual-level risk factors of incarcerated youth. Remedial Spec Educ. 2016;37(3):172-186. doi:10.1177/0741932515593383 38. Forrest CB, Tambor E, Riley AW, Ensminger ME, Starfield B. The health profile of incarcerated male youths. Pediatrics. 2000;105(1, pt 3)(suppl 2):286-291. doi:10.1542/peds.105.S2.286 37. 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