Background: Although some studies have found that incarceration is associated with young adults' poor health, confounding factors including adolescent health risks, and mediating influences such as stress have not been examined in the same study. We assessed whether variation in criminal justice system experience (none, arrest only, incarceration) influenced young adults' self-reported depressive symptoms and poor physical health after accounting for prospective risks to health including adolescent health risks. We then assessed whether stress mediated associations between criminal justice involvement and the two health indicators.

Methods: Data are from Toledo Adolescent Relationships Study (TARS) (n =990), which included young adults, age 22-29, who have matured during the era characterized by mass incarceration. The dependent variables included a depressive symptoms scale and self-reported poor health. The adolescent health risks included economic disadvantage, body mass index, delinquency, problems with drugs, and prior depressive symptoms. We considered stress as a mediating variable. Sociodemographic characteristics included race/ethnicity, age, and gender. We used ordinary least squares regression and logistic regression analyses. We tested gender, race/ethnicity, and age interactions.

Results: In multivariable models, incarceration, and adolescent health risks (economic disadvantage, prior depression, problems with drugs) were associated with young adults' depressive symptoms, and stress was a mediating influence. Adolescent delinquency and stress, but not incarceration, were significantly associated with young adults' self-reported poor health.

Conclusion: This study provided a more nuanced understanding of incarceration and health by accounting for several key confounding factors and testing stress as a mechanism underlying the association. Care for prisoner health during and after incarceration is important for successful reintegration.