Exploring the Relationship Between Parental Incarceration, Government Programs, and Child Health and Flourishing

Background: One in 14 children in the US has had an incarcerated parent, an experience more common among Black and Indigenous children and associated with negative long-term health consequences. While the consequences of such exposure likely worsen racial health inequities, existing studies examining the association between parental incarceration and child health and well-being are dated, limited in their scope, and do not identify structural solutions to improving health inequities.

The objective of this study was to describe the relationship between parental incarceration and child health and flourishing—a measure of a child’s curiosity, resilience, and self-regulation—and identify structural interventions, specifically government programs, that moderate this relationship.

Methods: We performed a cross-sectional analysis including children ages 6-17 years old in a nationally representative dataset: the National Survey of Children’s Health (2016-19). Using logistic regression, we estimated the association between ever having a parent incarcerated and overall health and flourishing, controlling for age, sex, birthweight, nativity, caregiver health, presence of a biological/adoptive parent in the household, household size, income, and primary language. Secondary outcomes included physical health diagnoses (asthma and headaches), behavioral health diagnoses (ADD/ADHD and depression), developmental needs (learning disability or use of a special educational plan), and educational achievement (missing ≥11 days of school or repeating a year of school). Finally, we performed interaction analyses to determine whether enrollment in government programs including the Supplemental Nutrition Assistance Program (SNAP), Women, Infants, and Children (WIC), free and reduced lunch, cash assistance, or Medicaid moderated the relationship between parental incarceration and child health and flourishing.

Results: Children with parental incarceration accounted for 9.3% of the survey sample (weighted n=17,703,172). Black, American Indian/Alaska Native, and multi-racial children experienced parental incarceration at disproportionately high rates (Table 1). In multivariable logistic regression models, children with parental incarceration had a higher odds of reporting worse health (aOR 1.35, 95% CI 1.07, 1.70) and of not flourishing (aOR 1.63, 95% CI 1.38, 1.92). Children with parental incarceration also had increased odds of having asthma, frequent/severe headaches, ADD/ADHD, depression, a learning disability, a special education plan, missing ≥11 days of school, and repeating a grade in school compared with children without incarcerated parents (Table 2). We found that not participating in WIC, free and reduced lunch, and Medicaid was associated with worse overall health for children with parental incarceration. Not participating in food stamps and cash assistance programs was associated with a decreased likelihood of flourishing in children with parental incarceration.

Conclusion: Our study demonstrates that experiencing parental incarceration is associated with worse child health and well-being. Expanding state and federal safety net programs and eliminating laws which prohibit formerly incarcerated individuals from accessing benefits may mitigate the intergenerational health-harms associated with parental incarceration, which are disproportionate among Black and Indigenous children.