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Original Investigation | Public Health

Incarceration of Youths in an Adult Correctional Facility
and Risk of Premature Death
Ian A. Silver, PhD; Daniel C. Semenza, PhD; Joseph L. Nedelec, PhD

Abstract
IMPORTANCE Youths incarcerated in adult correctional facilities are exposed to a variety of adverse
circumstances that could diminish psychological and physical health, potentially leading to early
mortality.

Key Points
Question Is incarceration of youths in
adult correctional facilities associated
with an increased risk of mortality
through 39 years of age?

OBJECTIVE To evaluate whether being incarcerated in an adult correctional facility as a youth was

Findings In this cohort study of 8951

associated with mortality between 18 and 39 years of age.

youths, incarceration in an adult
correctional facility before the age of 18

DESIGN, SETTING, AND PARTICIPANTS This cohort study relied on longitudinal data collected

years was associated with a 33%

from 1997 to 2019 as part of the National Longitudinal Survey of Youth–1997, a nationally

increase in the risk of mortality between

representative sample of 8984 individuals born in the United States between January 1, 1980, and

18 and 39 years of age.

December 1, 1984. The data analyzed for the current study were derived from annual interviews
between 1997 and 2011 and interviews every other year from 2013 to 2019 (19 interviews in total).
Participants were limited to respondents aged 17 years or younger during the 1997 interview and
alive during their 18th birthday (8951 individuals; >99% of the original sample). Statistical analysis
was performed from November 2022 to May 2023.

Meaning This study suggests that
incarceration in an adult correctional
facility as a youth was associated with
early mortality, potentially through
diminished psychological and
physical health.

INTERVENTION Incarceration in an adult correctional facility before the age of 18 years compared
with being arrested before the age of 18 years or never arrested or incarcerated before the age of
18 years.
MAIN OUTCOMES AND MEASURES The main outcome for the study was age at mortality between
18 and 39 years of age.

+ Invited Commentary
+ Supplemental content
Author affiliations and article information are
listed at the end of this article.

RESULTS The sample of 8951 individuals included 4582 male participants (51%), 61 American Indian
or Alaska Native participants (1%), 157 Asian participants (2%), 2438 Black participants (27%), 1895
Hispanic participants (21%), 1065 participants of other race (12%), and 5233 White participants
(59%). A total of 225 participants (3%) died during the study period, with a mean (SD) age at death
of 27.7 (5.9) years. Incarceration in an adult correctional facility before the age of 18 years was
associated with an increased risk of earlier mortality between 18 and 39 years of age compared with
individuals who were never arrested or incarcerated before the age of 18 years (time ratio, 0.67; 95%
CI, 0.47-0.95). Being arrested before the age of 18 years was associated with an increased risk of
earlier mortality between 18 and 39 years of age when compared with individuals who were never
arrested or incarcerated before the age of 18 years (time ratio, 0.82; 95% CI, 0.73-0.93).
CONCLUSIONS AND RELEVANCE In this cohort study of 8951 youths, the survival model suggested
that being incarcerated in an adult correctional facility may be associated with an increased risk of
early mortality between 18 and 39 years of age.
JAMA Network Open. 2023;6(7):e2321805. doi:10.1001/jamanetworkopen.2023.21805

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Incarceration of Youths in an Adult Correctional Facility and Risk of Premature Death

Introduction
Incarceration exposure is associated with early mortality.1-3 Research documents a dose-response
association such that more time served in prison corresponds to greater reductions in life span.4
Mortality excesses associated with incarceration translate to losses of life expectancy of 4 to 5 years,
or roughly 13% of the average US life expectancy at the age of 45 years.5 Numerous mechanisms
have been shown to link incarceration to early mortality, including greater risk for violent
victimization and homicide,6 substance use and overdose,7,8 and higher incidence of chronic and
infectious disease.9,10
A smaller body of research documents the association of incarceration exposure with early
mortality specifically among youths, legally defined as children younger than 18 years.11 Youths with
a history of incarceration have an all-cause mortality rate roughly 5.9 times higher than observed in
nonincarcerated Medicaid-enrolled youths of the same age, associated largely with exposure to
violence and homicide victimization.6 Incarcerated youths face greater risk for early death than
nonincarcerated youths as involvement in the criminal legal system becomes more protracted and
severe.12 Youths who are incarcerated experience health challenges related to dental care, sexual and
reproductive health, risk-taking behaviors, and mental well-being that heighten the likelihood of
early death.13
In most US states, youths can be transferred and sentenced in adult court, resulting in detention
in adult prison facilities.14,15 Incarceration in juvenile vs adult correctional facilities represents vastly
different experiences. Adult facilities are often much larger, have higher resident to staff ratios, and
place less emphasis on treatment, counseling, and education.16 Even though only approximately 1%
of formally processed juvenile delinquency cases are transferred to an adult criminal court,17 research
documents serious extralegal consequences for youths incarcerated in adult facilities. Youths
incarcerated in adult facilities report substantially greater rates of posttraumatic stress disorder and
depression compared with those in juvenile facilities.18-20 In Texas, youths in adult facilities reported
more distress and higher rates of psychiatric symptoms than those in juvenile centers.18 Most salient
to the present study, researchers have observed that detention in jail and transfer to adult court
were associated with early mortality among a sample of youths in Indiana.12
Young people housed in adult correctional facilities report being more afraid for their safety.14
Youths incarcerated in adult facilities are more likely to engage with antisocial adult peers in prison
environments, exposing them to greater risk for sexual and physical assault.18,21,22 Youths in adult
facilities often struggle to adjust to prison life and display heightened rates of disciplinary misconduct
and violence, which can lead to further isolation and loss of socialization during critical
developmental periods.23 Incarceration among adults is likely to have damaging iatrogenic effects for
youths as a result of more harmful exposures in prison and disruption to key social, psychological,
and developmental processes. Poorer mental and physical health, greater risk for violence and
victimization, and higher engagement in risky behaviors, such as substance abuse, may be associated
with early mortality after release for those who have been incarcerated as a youth in an adult facility.
We hypothesize that juvenile incarceration in an adult correctional facility will be associated
with greater risk for early mortality after accounting for broader exposure to the criminal legal system
via arrests, associated risk factors, and demographic differences.

Methods
Analytical Sample
The current study follows the Strengthening the Reporting of Observational Studies in Epidemiology
(STROBE) reporting guideline for reporting by satisfying all the applicable items (1-21) in terms of
reporting on a secondary publicly available cohort study. We did not seek institutional review board
approval as the study relied on publicly available deidentified data that can be retrieved by anyone.
The approval for the data collection was obtained by the institutional review boards at The Ohio
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State University and National Opinion Research Center at the University of Chicago by the NLSY97
research team, with which we have no affiliation. All data documentation associated with the
National Longitudinal Study of Youth–1997 (NLSY97) is provided on the website of the US Bureau of
Labor Statistics. The data for the current study are derived from the publicly available version of the
NLSY97, a nationally representative sample of individuals born in the United States between January
1, 1980, and December 1, 1984.24 The 8984 respondents agreed to participate in yearly interviews
from 1997 to 2011 and in interviews every 2 years from 2013 to 2019. In total, 19 interviews have
been completed, with the respondents ranging in age from 12 to 18 years during the 1997 interview
and from 34 to 39 years during the 2019 interview. If a respondent was incarcerated at the time of
the interview, the interview was completed in person in a visitation room or via telephone at no cost
to the respondent. The analytical sample included respondents who were 17 years of age or younger
during the 1997 interview and alive during their 18th birthday (8951 individuals; >99% of the original
sample). Because the study uses publicly available deidentified data, consent was not obtained from
any respondents.

Measures
Dependent Variables: Death and Age at Death
Respondents who did not complete an interview because they died were identified as part of the
nonresponse tracking for the NLSY97. With the use of this information, 2 variables were created.
First, a variable for death was created to indicate if a respondent died between 18 and 39 years of age
(0 = no; 1 = yes). Of the 8951 individuals included in the sample, 225 (3%) died between 18 and 39
years of age. The mortality rate observed in the NLSY97 is consistent with the estimates produced by
the US Social Security Office.25 Second, a respondent’s age at death was recorded as their age during
the year they died, as reported by family members or friends. The NLSY97 research team did request
and confirm death records for all respondents using official data sources from state agencies.
Consistent with the implementation of a survival analysis, the age at the final interview was also
recorded in the age at death measure for individuals who did not die between 18 and 39 years of age.
Key Independent Variables: Arrest and Incarceration in Adult Correctional Facilities
The respondents were requested to report the date of each arrest and the start and end date for each
incarceration period since their last interview. The NLSY97 research team developed monthly arrays
identifying the number of arrests a respondent experienced and if a respondent was incarcerated at
any point during a specified month from 1992 to 2019. Due to concerns associated with privacy, the
NLSY97 research team considered an individual incarcerated during a specified month if they spent 1
or more days in the correctional facility during that month. With the use of the monthly arrays and
the age of the respondent each year, 2 variables were created to measure whether a respondent was
arrested or incarcerated before the age of 18 years (0 = no; 1 = yes). Two continuous variables were
created to measure the number of arrests and the number of months incarcerated that each
respondent experienced before the age of 18 years. Periods of confinement associated with status
offenses (eg, truancy), holds for DUI (driving under the influence of alcohol or drugs), holds for public
intoxication, pretrial detention, and confinement in juvenile detention centers were excluded from
the monthly arrays for incarceration created by the NLSY97 research team. The measures created for
the current study capture data on whether an adolescent was incarcerated in an adult correctional
facility (jail or prison) and the number of months spent in an adult correctional facility.26
Control Variables: General Risk Factors and Demographic Characteristics
Study variables were selected to limit the potential bias associated with colliders and
confounders—and exclude mediators—following the development of a theoretically and empirically
formed, directed acyclic graph (eAppendix 1 and eFigure in Supplement 1).1,10,12,13 Four covariates
known to be associated with contact with the criminal legal system and early mortality were included
in the survival model.27,28 These covariates include items measuring the self-rated general health of
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the respondent before the age of 18 years (0 = poor; 1 = fair; 2 = good; 3 = very good; 4 = excellent;
measured in 1997),29,30 whether 1 or both of the respondent’s parents were incarcerated before the
respondent turned 16 years of age, whether the respondent experienced childhood adversity (eg,
experienced homelessness, lived in a place without water or electricity, or resided in emergency
housing) before the age of 18 years, and the respondent’s household net worth before the age of
18 years.
In addition to these risk factors, demographic characteristics were adjusted for the inclusion of
male sex (reference = female sex), ethnicity (Hispanic; reference = non-Hispanic), and race
(American Indian or Alaska Native, Asian, Black, White; reference was other race [including
individuals of multiple races and individuals who did not identify a race after initially identifying as
Hispanic]). A dichotomous indicator (supplemental sample) for the NLSY97 sample in which the
respondent participated (0 = initial sample; 1 = supplemental sample) was also included in the model
to adjust for possible differences in the sampling procedures.24

Statistical Analysis
Statistical analysis was performed from November 2022 to May 2023. A 4-part analytical strategy
was implemented. First, a missing data analysis was conducted, and multiple imputation using the
random forest method (continuous constructs) and the logistic regression method (dichotomous
constructs) was implemented to impute missing values on the covariates (eAppendix 2, eTable 1, and
eTable 2 in Supplement 1).31 The imputed values for the covariates represent the combination of 5
imputed data sets with 10 iterations each (pulled using the complete function from the mice package
in R, version 4.2.3 [R Project for Statistical Computing]).31 No information was missing on the number
of arrests, the number of months incarcerated, or the death status of the respondents. Second,
descriptive statistics were produced. Third, death status and the age at death were regressed on the
independent and control variables using a parametric survival model. The parametric survival model
was estimated using a lognormal distribution given the distributional properties of age at death. An
intercept-only model was estimated with each distributional specification—lognormal, exponential,
Weibull, gaussian, logistic, and loglogistic—and the resulting Akaike information criteria were
compared. A parametric survival model was preferred for the current analysis because the
association between the independent variables and the dependent variable did not satisfy the
proportional hazard assumption of a Cox proportional hazards regression survival model.32-34 The
time ratio (TR) represents the risk of an event occurring across all time periods, where values higher
than 1 indicate an increased odds of survival and values lower than 1 indicate an increased risk of
death. The TR is calculated as the exponentiated value of the slope coefficient (exp [b]). The
cumulative probability of death was calculated and plotted to permit a visual evaluation of the
results. All P values were from 2-sided tests and results were deemed statistically significant at
P < .05. All analyses were estimated using the survival35 and the SurvMetrics packages in R, version
4.2.3.36 To maintain open science, the R script used to clean the data and estimate all of the statistical
analyses is provided in eAppendix 4 in Supplement 1.

Results
The analytical sample of 8951 individuals included 4582 male participants (51%), 61 American Indian
or Alaska Native participants (1%), 157 Asian participants (2%), 2438 Black participants (27%), 1895
Hispanic participants (ethnicity; 21%), 1065 participants of other race (12%), and 5233 White
participants (59%) (Table 1). A total of 225 respondents (3%) died during the study period, with a
mean (SD) age at death of 27.7 (5.9) years. A total of 1597 of the respondents (18%) in the analytical
sample were arrested before the age of 18 years, while 109 respondents (1%) were incarcerated as
youths in an adult correctional facility. Some youths experienced as many as 17 arrests and were
incarcerated for up to 3.5 years in an adult facility.

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Table 2 provides the results of the parametric survival model that assessed the likelihood of
death before the age of 39 years. Incarceration of youths in an adult correctional facility was
associated with an approximate 33% increase in the risk of death (TR, 0.67; 95% CI, 0.47-0.95)
compared with nonincarcerated youths. In addition, being arrested before the age of 18 years was
associated with an increase in the risk of death until the age of 39 years (TR, 0.82; 95% CI, 0.73-0.93)
compared with not being arrested. Neither the number of months of incarceration in an adult facility
(TR, 1.02; 95% CI, 0.99-1.06) nor the number of arrests (TR, 1.00; 95% CI, 0.97-1.04) were associated
with the risk of death prior to 39 years of age. Better general health before 18 years of age was
associated with a higher likelihood of survival (TR, 1.10; 95% CI, 1.05-1.15), while being male was
associated with a higher risk of early death (TR, 0.84; 95% CI, 0.77-0.91).
We plotted the cumulative probability of death for youths incarcerated in adult correctional
facilities, arrested youths, and respondents without legal system contact before 18 years of age. As
shown in the Figure, approximately 8% of youths incarcerated in adult correctional facilities were
estimated to die by the age of 39 years. In comparison, just over 5% of youths arrested before 18
years of age and just over 2% of youths without legal system contact before the age of 18 years were
estimated to have died by the age of 39 years. Overall, the findings suggest that contact with the
legal system as a youth—both arrest and, especially, incarceration in adult correctional facilities—was
associated with an increased risk of death between 18 and 39 years of age. Supplemental analyses
(eAppendix 3, eTable 3, and eTable 4 in Supplement 1) assessed whether the findings held after
accounting for time served in a juvenile facility. The association between incarceration in an adult
correctional facility and an increased risk of death remained virtually identical (TR, 0.67; 95% CI,
0.47-0.95) (eTable 4 in Supplement 1).

Table 1. Descriptive Statistics for the Analytical Sample (N = 8951)
Characteristic

No. (%)
(N = 8951)

Mean (SD)

Range

Key dependent variable (aged 18-39 y)
Death
Age at death, y

225 (3)

0.03 (0.16)

0 to 1

NA

27.7 (5.9)

18 to 39

109 (1)

0.01 (0.11)

0 to 1

NA

0.08 (1.12)

0 to 42

1597 (18)

0.17 (0.37)

0 to 1

NA

0.38 (1.19)

0 to 17

Key independent variables (before age 18 y)
Incarcerated in adult facility
No. of months incarcerated in adult facility
Arrested
No. of arrests
General risk factors
Self-rated health before age 18 y

NA

3.06 (0.91)

0 to 4

Parental incarceration before age 16 y

623 (7)

0.07 (0.25)

0 to 1

Childhood adversity

489 (5)

0.05 (0.23)

0 to 1

Household net worth before the age of 18 y, $

NA

92 288 (139 363) −935 251 to 600 000

Male

4582 (51)

0.51 (0.50)

0 to 1

Female

4369 (49)

0.49 (0.50)

0 to 1

Hispanic

1895 (21)

0.21 (0.41)

0 to 1

Non-Hispanic

7056 (79)

0.79 (0.41)

0 to 1

American Indian or Alaska Native

61 (1)

0.006 (0.08)

0 to 1

Asian

157 (2)

0.02 (0.13)

0 to 1

Black

2438 (27)

0.27 (0.45)

0 to 1

Othera

1065 (12)

0.12 (0.32)

0 to 1

White

5233 (58)

0.58 (0.49)

0 to 1

2230 (25)

0.25 (0.43)

0 to 1

Demographics
Sex

Ethnicity

Race

Abbreviation: NA, not applicable.
a

Supplemental sample

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Includes individuals of multiple races and individuals
who did not identify a race after initially identifying
as Hispanic.
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Discussion
Although a relatively large body of literature highlights the detrimental associations of incarceration
exposure with health overall, a much smaller segment has focused on such associations for youths
imprisoned in adult facilities. Youths incarcerated in adult facilities experience a system that is not
designed for the crucial developmental years of adolescence, where neuronal and social factors
interact to affect personality and behavioral outcomes across the life course.37 Instead, such youths
encounter a system intended exclusively for socially matured individuals. Within such a system,
youths may not only engage in risky and harmful behaviors37 but they may directly experience risk
factors associated with the likelihood of early mortality. Experiences of incarceration have been

Table 2. Parametric Survival Model Regressing Age at Death on Arrest as a Youth and Incarceration
in an Adult Facility as a Youtha
Dependent variable: age at death (18-39 y)

b (SE) [95% CI]

Time ratio (95% CI)

Incarceration in adult facilityb

−0.40 (0.18) [−0.75 to −0.05]

0.67 (0.47 to 0.95)

No. of months incarcerated in adult facility

0.02 (0.02) [−0.01 to 0.06]

1.02 (0.99 to 1.06)

Arrestedb

−0.20 (0.06) [−0.32 to −0.07]

0.82 (0.73 to 0.93)

No. of arrests

0.00 (0.02) [−0.03 to 0.04]

1.00 (0.97 to 1.04)

Key independent variables (before age of 18 y)

General risk factors
Self-rated healthb

0.09 (0.02) [0.05 to 0.14]

1.10 (1.05 to 1.15)

Parental incarceration before 16 yb

−0.17 (0.07) [−0.31 to −0.04]

0.84 (0.74 to 0.96)

Childhood adversity

0.00 (0.09) [−0.17 to 0.17]

1.00 (0.84 to 1.18)

Household net worth before 18 yb

0.00 (0.00) [0.00 to 0.00]

1.00 (1.00 to 1.00)

Maleb

−0.17 (0.04) [−0.26 to −0.09]

0.84 (0.77 to 0.91)

American Indian or Alaska Native (reference: other)

0.02 (0.30) [−0.57 to 0.61]

1.02 (0.56 to 1.84)

Asian (reference: other)

0.27 (0.28) [−0.28 to 0.81]

1.31 (0.76 to 2.26)

Black (reference: other)

−0.16 (0.10) [−0.36 to 0.04]

0.85 (0.70 to 1.04)

Hispanic (reference: non-Hispanic)

0.08 (0.07) [−0.06 to 0.22]

1.08 (0.94 to 1.25)

White (reference: other)

−0.07 (0.10) [−0.25 to 0.12]

0.94 (0.78 to 1.13)

Supplemental sample

0.05 (0.06) [−0.06 to 0.16]

1.05 (0.94 to 1.17)

−0.32 (0.05) [NA]

NA

Demographic characteristics

Log (scale)
Model log likelihood

−1684.7

Intercept only log likelihood

−1737.1

Scale

0.723

No.

8951

Abbreviation: NA, not applicable.
a

Following the Akaike information criterion, it was
determined that the parametric survival model
should be estimated using a lognormal distribution
given the distributional properties of age at death.

b

Indicates P < .05.

Figure. Cumulative Probability of Dying by Age for Varying Types of Contact With the Legal System
0.12

Cumulative probability of death

0.10

0.08
Incarcerated <18 y
0.06

0.04
Arrested <18 y
0.02
No CLS contact
0
18

21

24

27

30

33

36

Age, y

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39

The cumulative probability of dying by the
corresponding age was estimated using the results
from the model presented in Table 2. Incarcerated <18
y indicates ever spending time in an adult correctional
facility as a youth. CLS indicates criminal legal system.

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associated with a variety of detrimental outcomes related to well-being; however, to date, no study
has examined the extent to which these experiences may be associated with premature death in a
national sample, to our knowledge. The current study addressed this gap in the literature using a
longitudinal, nationally representative sample of US youths.
The analyses revealed 3 key findings. First, while a relatively small proportion of youths in the
analytical sample were incarcerated in an adult facility, there was substantial variability in the length
of exposure. Second, our multivariable models accounted for several general risk factors associated
with health, family background, and socioeconomic status, yet the association between exposure to
an adult correctional facility and early mortality remained. This association is illustrated in the Figure,
where the proportion of youths who were estimated to die by the age of 39 years appeared to be
approximately 3 times higher for those who were incarcerated in an adult facility compared with
those without contact with the legal system. Third, while it appears that any formal contact with the
legal system was associated with an increased risk of premature death, being incarcerated in an adult
facility as a youth evinced the highest risk for early mortality. The findings of the supplemental
models further suggest that the circumstances to which youths are exposed during incarceration in
adult correctional facilities could be associated with detrimental health outcomes because
incarceration in juvenile correctional facilities was not associated with early mortality (eAppendix 3,
eTable 3, and eTable 4 in Supplement 1).
Overall, these results point to a handful of potential explanations. First, any exposure to an adult
correctional facility as a youth may have an association with early mortality beyond other risk factors,
such as general health, being male, and early contact with the legal system. Several potential
mechanisms are plausible that align with prior research on the detrimental effects of incarceration
(eg, increased risk for violent victimization, substance use, disease, and harmful behaviors).6,7,9
These associations, however, were examined in prior literature using adult prisoners in adult facilities.
Thus, it is conceivable that the associations are exacerbated when experienced by youths in an adult
facility. Future research should further assess potential mechanisms of the association
observed here.
Second, the observed association may not be causal but instead indicative of a process
unrelated or tangentially related to the legal system. Youths who are incarcerated tend to possess
health-related risk factors at much higher rates than youths who do not experience
incarceration.38,39 Consequently, the mortality risk factors that youths bring with them to the
incarceration process may be amplified by experiences in adult correctional facilities. Whether the
association is causal or a function of the risk factors that youths bring with them (or both), the
findings observed in the current study highlight the need for rethinking the practice of transferring
youths to adult facilities to avoid the potential lethality of such exposure.

Limitations
Although the current study illustrated an increased likelihood of early mortality for youths
incarcerated in adult facilities, at least 5 limitations should temper the findings. First, there could be
aspects of the NLSY97 cohort used to form the analytical sample that were associated with the
observed findings.40 Second, the data do not provide for a nuanced assessment of the potential
mechanisms for the observed patterns. For example, heterogeneity in the experience of adult
facilities among youths transferred to such prisons in the analytical sample is a potential factor
associated with the increased likelihood of early death. Third, due to data limitations, the NLSY97
does not identify the cause of death. Fourth, a limited number of individuals died between 18 and 39
years of age (n = 225), and the current study can be generalized only to the birth cohort of individuals
born in the US between 1980 and 1984. Fifth, due to the existing literature and the measures
available in the NLSY97, the current study adjusted only for mechanisms known to confound the
association of interest. Future studies should consider additional confounders not measured or
available in the NLSY97.

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Conclusions
Our cohort study illustrates that incarcerating youths in adult correctional facilities is potentially very
harmful. The observed association between youth imprisonment in adult correctional facilities and
increased risk of mortality further illustrates a need for reassessment of this practice. Furthermore,
the results emphasize the importance of considering the health-related needs of youths while
pursuing rehabilitation in prison.9,10,18 Prevention and intervention efforts should be directed at
factors to ameliorate the potential extralegal harm—including lethal impacts—of placing youths in
adult correctional facilities.

ARTICLE INFORMATION
Accepted for Publication: May 12, 2023.
Published: July 5, 2023. doi:10.1001/jamanetworkopen.2023.21805
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2023 Silver IA
et al. JAMA Network Open.
Corresponding Author: Ian A. Silver, PhD, Center for Legal Systems Research, RTI International, 3040 E
Cornwallis Rd, Research Triangle Park, NC 27709 (isilver@rti.org).
Author Affiliations: Center for Legal Systems Research, RTI International, Research Triangle Park, North Carolina
(Silver); Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey
(Semenza); New Jersey Gun Violence Research Center, Department of Urban-Global Health, School of Public
Health, Rutgers University, New Brunswick, New Jersey (Semenza); School of Criminal Justice, University of
Cincinnati, Cincinnati, Ohio (Nedelec).
Author Contributions: Dr Silver had full access to all of the data in the study and takes responsibility for the
integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: Silver, Nedelec.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Silver, Nedelec.
Conflict of Interest Disclosures: None reported.
Data Sharing Statement: See Supplement 2.
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SUPPLEMENT 1.
eAppendix 1. Directed Acyclic Graph to Guide Model Selection
eReferences.
eFigure. Directed Acyclic Graph Guiding the Selection of Covariates
eAppendix 2. Missing Case Information
eTable 1. Descriptive Statistics for the Analytical Sample Before Imputation (N = 8,951)
eTable 2. Missing Case Comparison for Key Constructs Before Imputation (n = 8,951)
eAppendix 3. Model Replications With Youth Incarcerated in Juvenile Facilities
eTable 3. Parametric Survival Model Regressing Age at Death on Being Incarcerated in a Juvenile Facility
eTable 4. Parametric Survival Model Regressing Age at Death on Being Incarcerated in a Juvenile Facility, Arrested
as a Juvenile, and Incarcerated in an Adult Facility as a Juvenile
eAppendix 4. R Script
SUPPLEMENT 2.
Data Sharing Statement

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