2025 Theses Doctoral

“I’m Already Channeled Out by the World, Lemme Go Ahead and Get Drinking”: Sex Offender Registration and Notification Policies as Social Determinants of Behavioral Health

Shefner, Ruth Tamara

As of 2017, there were approximately 861,000 people in the U.S. required to register under sexual offender registration and notification policies. While evidence indicates that these policies do not deter sexual offending or prevent recidivism, these policies do have significant effects on the wellbeing of registrants and their communities. Registrants face numerous policy and legal proscriptions, such as residency restrictions that prohibit them from living in proximity to schools or public spaces, exclusion from public housing and shelters, and ineligibility for federal funds directed towards reentry, vocational, or social services. Moreover, they experience intense stigma and alienation, which often manifest as abandonment by social networks, exclusion from community spaces, and overt discrimination and harassment.

Many of the severely destabilizing collateral consequences of sex offender registration policies are also known risk factors for substance use. These policies and restrictions may therefore create or exacerbate a substance use risk environment and increase the likelihood of substance-use-related harms, including interpersonal harms. However, no public health research has directly examined relationships between sex offender registration policies and substance use related harms. This dissertation identifies and addresses this gap in knowledge through a rapid review of the collateral consequences literature, followed by studies based on 44 qualitative interviews with people required to register in Philadelphia and the 20 qualitative interviews with professional stakeholders who work with them.

The rapid review yielded 42 peer reviewed studies and governmental reports documenting the collateral consequences of sex offender registration and notification policies. Consequences typically fell into the categories of housing, employment, education, relationships, mental health, criminal justice, stigma, and safety. Housing was the most frequently reported barrier, closely followed by employment and stigma. Only one study alluded to substance use, and no studies focused their attention on substance use related harms. Most studies were published in criminal justice and/or forensic psychology journals, and no literature was published in public health journals.

Six key themes emerged from 20 qualitative semi-structured interviews with criminal legal, substance use, and forensic stakeholders who work with people required to register in Philadelphia. These themes described how 1) “sex offender” is an extremely stigmatized and villainized identity, 2 & 3) how sex offender registration related restrictions transform the social and material context of reentry, 4) how both the formal restrictions and the labeling have detrimental impacts on mental health and self-concept, 5) how these material and psychosocial consequences of SORN increase substance use risk and restrict access to court-referred drug treatment, and 6) how the overall landscape has dangerous and destructive implications, especially for overdose risk.

Forty-four interviews with adult men required to register in Philadelphia yielded similar themes that broadly illustrated the challenging reentry landscape faced by people required to register, as well as the impacts of sex offender registration policies on health and wellbeing. These themes documented how 1) sex offender registration policies enact formal barriers—such as residency restrictions--that cultivate a restricted reentry landscape, 2) how registration policies and the sex offender label have wide ranging and significant interpersonal effects, 3) how both the formal and informal barriers impact the mental health of people required to register, and 4) how all of these consequences impact substance use related harms.

Results suggest that sex offender registration and notification laws operate as social determinants of poor health for registrants and are previously unstudied collateral consequences of sex offender criminalization. These findings provide evidence for social service providers, funders, policy advocates, and officials on the need to reform harmful and ineffective policies and improve access to treatment services for people required to register.