Association Between Social Adaptability Index Score and Lifetime Criminal Legal Involvement in U.S. Adults

• Published in: Health equity Vol. 6; no. 1; pp. 240 - 247
• Main Authors: Hawks, Laura C, Walker, Rebekah J, Egede, Leonard E
• Format: Journal Article
• Language: English
• Published: United States Mary Ann Liebert, Inc 01-03-2022; Mary Ann Liebert, Inc., publishers; Mary Ann Liebert
• Subjects: Adaptability; Age; Alcohol; Chronic illnesses; College graduates; Diabetes; Disease; Divorce; Drug abuse; Drug use; Education; Employment; Ethnicity; Health care industry; Health insurance; Health services; Imprisonment; Insurance coverage; Mental disorders; Mental health; Mortality; Original Research; Population; Secondary schools; Socioeconomic factors; Tobacco; United States > US; health services research; social determinants of health; criminal justice involvement; incarceration; social risk
• ISSN: 2473-1242; 2473-1242
• DOI: 10.1089/heq.2021.0110

Exposure to the criminal legal system is associated with negative health outcomes and profound socioeconomic health disparities. The social adaptability index (SAI) is a validated composite scale based on five indicators of socioeconomic status; a higher score predicts better health outcomes. However, little is known about the relationship between cumulative social risk factors as measured by the SAI and lifetime criminal legal involvement (CLI).
Using a cross-sectional, nationally representative sample of U.S. adults, we calculated SAI score by lifetime CLI status, and used logistic regression with predictive margins to calculate risk of lifetime CLI by SAI quartile adjusting for demographic and clinical covariates.
A total of 213,678 participants were included, among whom 16.8% reported lifetime CLI. Mean SAI score was lower among those with lifetime CLI compared with those without (7.77, 95% confidence interval [CI]: 7.72-7.83 vs. 8.52, 95% CI: 8.50-8.55). There was a linear association between SAI quartile and predicted probability of lifetime CLI: first quartile: 23.9% (95% CI: 23.0-24.7); second quartile: 19.2% (95% CI: 18.6-19.8); third quartile: 17.5% (95% CI: 16.9-18.1); and fourth quartile: 12.5% (95% CI: 12.1-13.0).
The SAI score is associated in a reverse linear manner with lifetime risk of CLI, suggesting that to successfully improve health outcomes among those with CLI, interventions may need to target multiple SAI components simultaneously. Interventions that successfully position individuals to achieve higher social adaptability by targeting multiple factors may reduce the health-harming effects of exposure to the criminal legal system.