Unlocking the hidden health toll of incarceration
Linda Teplin’s innovative longitudinal health study at Northwestern explores how incarceration influences aging, chronic disease, and Alzheimer’s risk
A $20 million NIH grant is driving a bold new initiative at Northwestern University to unravel a pressing and largely unexplored question: How does incarceration shape health and accelerate aging, and what role does it play in increasing the risk of Alzheimer’s disease and related dementias (ADRD)? At the heart of this ambitious study lies a powerful dataset, three decades in the making, that has the potential to fundamentally shift how we understand the ripple effects of incarceration on long-term health—especially for Black and Hispanic individuals who disproportionately bear the weight of both mass incarceration and chronic health disparities.
Led by Linda Teplin of the Feinberg School of Medicine and principal investigator of the Northwestern Juvenile Project (NJP), the research builds on 30 years of robust data. The study will analyze a diverse cohort of 1,829 individuals whose data collection began in the 1990s when the participants were, on average, just 15 years old. Aimed initially at tracking health outcomes among youth in the juvenile justice system, the NJP now serves as a uniquely powerful dataset, comprising nearly 18,000 interviews conducted over multiple follow-ups.
“Incarceration is likely a critical health disparity,” said Teplin. “Yet, we have almost no data on how it creates and sustains disparities in health and aging and, ultimately, the risk for ADRD.”
The NJP’s data provides an in-depth view of incarceration as a “dose”—capturing its frequency, duration, type of facility, timing, and recency. This nuanced approach goes far beyond existing research, which often treats incarceration as a simplistic yes-or-no variable.
“Like any major health risk factor, incarceration must be analyzed in depth,” said Teplin, the Owen L. Coon Professor of Psychiatry and Behavioral Sciences and vice chair for research in her department. “For instance, the type and length of incarceration matter greatly. Health services differ significantly between jails, designed for short-term stays, and prisons, which house individuals serving longer sentences.”
Teplin says this new Northwestern study is entirely based at the University and has the potential to anchor future NIH grants in related areas, such as heart disease, cancer and psychiatric disorders.
The following Q&A with Professor Teplin explores the transformative potential of this research to inform public health, drive policy changes, and improve the lives of those most affected by the intersection of incarceration and chronic health conditions.
Matt Golosinski: Your study is the first to comprehensively examine incarceration's long-term health effects. Can you explain what motivated you to explore this connection and how your findings could reshape how we think about the aging process for formerly incarcerated individuals?
Linda Teplin: We’ve studied incarcerated populations for decades: men in jail, women in jail, youth in detention. To date, we’ve focused on examining their health needs and whether or not they received the services they needed. However, we have not yet had the opportunity to examine how incarceration affects health and aging. Our participants are now in mid-life. We have been collecting data on their dose of incarceration since the inception of the study. So, the stars aligned to be able to study how the dose of incarceration affects health and aging. Most people examine health disparities by studying patients and comparing how the services provided vary by race and social class. However, people like our participants may never enter the healthcare system. And they are the people most likely to suffer from dire health problems.
MG: How is your study different from prior incarceration and health studies?
LT: Many studies have established the relatively poor health of incarcerated populations. However, we know little about how and why incarceration affects health and age-related conditions. Prior studies relied on longitudinal surveys, such as CARDIA and ADD HEALTH, because they had large samples. However, these studies were not designed to study incarceration and collected only cursory data on incarceration (e.g., Ever incarcerated? Yes/No). Studying incarceration dichotomously is not how one studies a risk factor. For example, to study the consequences of smoking on lung disease, one would never categorize people as Ever smoked? Yes/No. Instead, they examine pack years, type of nicotine used, ages, etc. We must take the same approach in studying incarceration as a risk factor. It is DOSE, not a dichotomous (yes/no) variable. We will study the dose of incarceration—that is, the frequency and duration of status, type of facility—juvenile, jail, prison, age(s) and recency—and how all these variables affect overall health, age-related conditions, and risk factors for ADRD.
MG: The dataset you’ve built, with nearly 18,000 interviews collected since the 1990s, is unparalleled. How has this extensive longitudinal data helped you uncover unique insights into the health disparities incarcerated individuals face as they age?
LT: Few studies of incarcerated populations are longitudinal. Longitudinal studies are expensive and cumbersome to conduct, especially with highly mobile populations like ours. It’s much easier (and cheaper) to study patients, where you can collect data when they show up for their appointments. However, participants like ours never make it into the system. So they’re seldom investigated.
MG: Your research highlights critical intersections between incarceration, substance abuse, psychiatric disorders, and age-related diseases. What policy changes or interventions could address these compounded health challenges most effectively in the prison population and beyond?
LT: Let’s remember that 95% of people who are incarcerated eventually return to their communities, where they will struggle to obtain jobs, safe housing, stable relationships, public benefits, and reliable healthcare. Yet, few studies investigate them! Most studies do not sample from correctional institutions. Worse yet, if their original participants are incarcerated when their follow-up interviews are due, they are eliminated from the study and considered “lost to follow-up.” Thus, historically, we have the fewest data on people who, probabilistically, have the most health problems.
Moreover, incarceration disproportionately affects economically disadvantaged groups, and in particular, Black males. Based on national statistics, we estimated that one-fifth to one-third of Black males treated in community health settings will have been incarcerated. Thus, our study will guide community health providers to better address released prisoners' social, emotional, and physical needs. —Matt Golosinski