Health consequences of paternal incarceration using a future-treated control group.

BACKGROUND: Paternal incarceration is a now a common experience in the life course for young people in the United States that likely shapes health. This study examines the effect of paternal incarceration on adolescents’ health care access/utilization and health behaviors during adolescence. This study employs an innovative approach, which we refer to as the future treated control method, to adjust for unobserved heterogeneity by exploiting plausibly exogenous variation in the timing of paternal incarceration to develop a future treated control group. In this approach youth who have experienced paternal incarceration are compared to youth who will experience paternal incarceration after the outcomes are measured. Results are replicated using a linear probability model with a traditional reference group of those who have not experienced paternal incarceration. RESULTS: Paternal incarceration is associated with a higher probability of having no insurance (b = 0.06, p = 0.04), forgoing needed medical care (b = 0.09, p = 0.03), and receiving psychological counseling (b = 0.08, p = 0.01) after reducing unobserved heterogeneity. Paternal incarceration is not significantly associated with health behaviors when adjusting for unobserved heterogeneity, despite significant associations between paternal incarceration and alcohol and tobacco use using a traditional regression model. In this case, paternal incarceration has an independent effect on health care access and use in adolescence but not observed health behaviors. CONCLUSIONS: Paternal incarceration has implications for health care use during the transition to adulthood. Paternal incarceration should be considered a distinctive risk factor that contributes to health inequity in the U.S. and research on the collateral consequences of incarceration for families needs to address the threat of selection.