Incarceration and Nutritional Hardship: Considering the Link to Food Insecurity and Healthful Food Access
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This dissertation extends research examining the health and well-being consequences of incarceration by investigating two understudied forms of nutritional hardship: food insecurity and access to healthy food retailers. Specifically, this dissertation expands upon extant literature by addressing the following research questions: (1) What is the relationship between prior incarceration and food insecurity? (2) What is the relationship between prior incarceration and access to healthy food retailers? (3) Does access to healthy food retailers and factors that are considered consequences of incarceration mediate the association between prior incarceration and food insecurity? (4) Does access to healthy food retailers and food security status mediate the relationship between incarceration and (a) health and (b) nutritional behavior? To address these questions, this project draws from two data sources. First, using the National Longitudinal Study of Adolescent to Adult Health, I assess the link between incarceration and food insecurity, as well as health and nutritional outcomes. Second, the Center for Disease Control (CDC) Division of Nutrition, Physical Activity and Obesity collected data for the Modified Retail Food Environment Index (mRFEI) in 2008-2009, which is linked to Add Health data using census tract codes. The mRFEI represents the percentage of retailers that sell healthy food relative to unhealthy food retailers in a census tract and the 0.5-mile buffer around the census tract. These data are used to assess the relationship between incarceration and access to healthy food retailers. Findings suggest that when compared to respondents who did not have prior contact with the criminal justice system, formerly incarcerated individuals are more likely to be food insecure and live in census tracts with low access to healthy food retailers. The findings indicate that much of the relationship between incarceration and food insecurity is explained by financial difficulties, stress, and decreased social standing. However, when the reference category is changed to "arrested only" or "convicted only" respondents the association between incarceration and nutrition hardship outcomes are attenuated, suggesting that selection bias underlies the association. Finally, neither food insecurity or access to healthy food retailers mediate nutritional outcomes or the likelihood of having an unhealthy weight, although food insecurity was found to mediate the association between incarceration and subjective health status. Overall, the results call for further investigation of the complex relationship between incarceration, post-release nutritional hardships, and health.