Health Inequalities: Is Adolescent Involvement in the Legal System a Risk Factor for Reduced Health Care Access and Usage during Adulthood?

Abstract

Introduction: This study examined the association between being involved in the criminal legal system prior to age 18 and access to medical coverage and care in adulthood.

Methods: Data from the National Longitudinal Survey of Youth-1997 (NLSY-97) birth cohort was analyzed using ATE-Inverse Probability Weights and Poisson regression models to estimate differences in the probability of having health coverage or accessing medical care across four groups with varying involvement in the criminal legal system prior to age 18.

Results: Adolescents arrested before 18 had an 8.9 percent reduction in health insurance endorsement (2003-2021), a 3 percent reduction in routine checkup endorsement (2003-2021), and a 4 percent increase in visiting a doctor when sick (2003-2008) Adolescents incarcerated in juvenile facilities had a 29 percent decrease, a 16 percent decrease, and a 21 percent decrease in health insurance endorsement, routine checkup endorsement, and doctor visits when sick (respectively). Adolescents incarcerated in adult facilities before 18 had a 36 percent decrease, a 15 percent decrease, and a 7 percent increase in health insurance endorsement, routine checkup endorsement, and doctor visits when sick (respectively). These results suggest that adolescents with justice system involvement were less likely to have health insurance or to receive routine health care as adults when compared to adolescents without system involvement.

Discussion: Our results indicate that being arrested, incarcerated in a facility for juveniles, or incarcerated in a facility for adults as a minor may be linked to reduced access to medical insurance and medical care during adulthood.

Keywords: criminal legal system involvement, health insurance, healthcare; juvenile justice