摘要：Objectives. We estimated the effects of high incarceration rates on rates of sexually transmitted infections and teenage pregnancies. Methods. We calculated correlations between rates of incarceration in state prisons and county jails and rates of sexually transmitted infections and teenage pregnancies for each of the 100 counties in North Carolina during 1995 to 2002. We also estimated increases in negative health outcomes associated with increases in incarceration rates using negative binomial regression analyses. Results. Rates of sexually transmitted infections and teenage pregnancies, adjusted for age, race, and poverty distributions by county, consistently increased with increasing incarceration rates. In the most extreme case, teenage pregnancies exhibited an increase of 71.61 per 100000 population (95% confidence interval [CI]=41.88, 101.35) in 1996 after an increase in the prison population rate from 223.31 to 468.58 per 100000 population in 1995. Conclusions. High rates of incarceration can have the unintended consequence of destabilizing communities and contributing to adverse health outcomes. Community health pioneer Sidney Kark attributed high rates of syphilis in South Africa in the late 1930s to the socially destabilizing effects of migration related to the seeking of mining jobs. 1 Extreme gender ratio imbalances in the areas surrounding the mines led to sexual behaviors that facilitated the transmission of such diseases. Social epidemiologist Mark Lurie has documented similar effects associated with HIV/AIDS in present-day South Africa. 2 Because incarceration leads to a select portion of a community’s residents being removed from their families and neighborhoods, it is tantamount to “forced migration,” contributing to imbalances in neighborhood gender ratios and resulting in the potential for community health effects similar to those just described for South Africa. Moreover, such disruptions of families and social networks can degrade social cohesion and the norms that might otherwise prevent sexually transmitted diseases and teenage pregnancies. Since the early 1980s, rates of incarceration in the United States have tripled and are now the highest of any country in the world. Men are 10 times more likely than women to be incarcerated. In addition, African Americans are 6 times more likely than Whites to face incarceration. 3 Moreover, rates of several sexually transmitted infections (STIs), including HIV, are higher among African Americans than Whites, and this is especially the case among male African Americans. For example, in 2000 the gonorrhea rate among male non-Hispanic Blacks in the United States was 40 times greater than that among male non-Hispanic Whites. 4 Also, teenage pregnancies were 2.8 times more common among Blacks than among non-Hispanic Whites in 2000. 5 Finally, in a 1999 study of counties in North Carolina, Thomas and Sampson found bivariate correlations between rates of incarceration and rates of STIs. 6 North Carolina has 76 state prisons and 97 jails, and its rate of incarceration ranks 31st among the 50 states. 7 We analyzed county-level data from the state in an attempt to determine (1) the incarceration variables that would have the strongest correlations with community health effects, (2) whether these correlations would remain stable over time, and (3) whether there would be a lag in time between incarceration and observable community health effects.
