Date of Award

January 2020

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Emily A. Wang


Mass incarceration in America has far-reaching effects on individuals and their families. Although a large body of evidence has described the effects of incarceration on specific physical and social outcomes, there is almost no research on its effects on broader wellbeing, a more holistic measure of lived experience that can more sensitively reflect social welfare and structural vulnerability. The goal of this thesis is to assess the association between exposure to the American system of mass incarceration and wellbeing. We examine individual-level exposure to the broader criminal legal system (CLS), including police stops, arrests, and incarceration, and family-level exposure to incarceration among immediate and extended family members. We conducted a secondary analysis using de-identified data from the 2018 Family History of Incarceration Survey (FamHIS), a nationally representative, cross-sectional study of incarceration among family members (N=2815) which also includes items on individual CLS exposure and wellbeing. Wellbeing was measured using the 100 Million Healthier Lives Adult Wellbeing Assessment, a set of validated items that assess thriving or suffering within five domains of wellbeing: physical health, mental health, social wellbeing, spiritual wellbeing, and overall life evaluation. We calculated trends in wellbeing by individual and family CLS involvement, and used logistic regression to compare wellbeing across levels of individual and family CLS involvement, controlling for confounding by age, gender, race, income, housing type, employment status, education, marital status, family size, history of addiction, and individual incarceration. We estimate that 40% of Americans have had any police contact or incarceration, and about 60% of Americans have had any immediate or extended family member incarcerated. Thirty one percent of Black Americans have ever been incarcerated, compared to 17.4% of White Americans (P < 0.001). Twelve percent of Black Americans have had an immediate family member incarcerated for more than 10 years, compared to 1.4% of White Americans (P < 0.001). Compared to individuals without any CLS exposure, any personal CLS exposure was associated with lower wellbeing in every domain. Exposure to police stop and frisk was associated with similarly low wellbeing compared to multiple exposures to incarceration. Compared to individuals without any family incarceration exposure, any family incarceration was associated with lower wellbeing in every domain. Having increasing numbers of immediate family members incarcerated was associated with progressively lower wellbeing in every domain (P < 0.05 for each trend). Taken together, our findings show that any individual CLS exposure or family member exposure to incarceration is associated with decreased wellbeing in every domain. This suggests that criminal justice reform efforts to reduce police contact can improve population level wellbeing, and that clinical jail diversion and other decarceration efforts can further improve population-level wellbeing by preventing loss of individual and family member wellbeing.


This thesis is restricted to Yale network users only. It will be made publicly available on 09/10/2022