Violence exposure and health related risk among African American adolescent female detainees: A strategy for reducing recidivism

Disrupting the Trauma- To - Prison Pipeline For Justice-Involved Young Women Victimized By Violence

Background

Rates of aggressive offending among Justice-Involved Young Women (JIYW) have increased over the past few decades. Yet, there is little discourse, research, or intervention to address it among young women.

Aims/hypotheses

This study hypothesized that a higher capacity for self-restraint measured on the Weinberger Adjustment Inventory (WAI) scale among 14-18-year-old JIYW would moderate the relationship between the exposure to violence and serious aggressive offending.

Methods

The pathways to desistance project, a multi-site, longitudinal study, included a sample of JIYW aged 14-18 years old (n = 184). The baseline data were analyzed using linear multiple regression.

Results

After controlling for two variables, race and neighborhood conditions, the overall model was significant (F = 8.31 (df = 7,176), p = .001). The predictor variables (exposure to violence and self-restraint) explained 25% of the outcome variable (level of aggressive offending). The moderation result was significant such that higher self-restraint weakens the relationship between exposure to violence and aggressive offending (B = - 0.01, t (176) = -2.39, p = .018).

Conclusions/implications

This study highlights the need to disrupt the trauma- to- prison pipeline by enhancing positive social skills in a trauma-responsive manner, which could mitigate the effect of exposure to violence among JIYW.

DNA methylation and exposure to violence among African American young adult males

Exposure to violence (ETV) has been linked to epigenomics mechanisms such as DNA methylation (DNAm). We used epigenetic profiling of blood collected from 32 African American young adult males who lived in Washington DC to determine if changes in DNAm at CpG sites affiliated with nervous and immune system were associated with exposure to violence. Pathway analysis of differentially methylated regions comparing high and low ETV groups revealed an enrichment of gene sets annotated to nervous system and immune ontologies. Many of these genes are known to interact with each other which suggests DNAm alters gene function in the nervous and immune system in response to ETV. Using data from a unique age group, young African American adult males, we provide evidence that lifetime ETV could impact DNA methylation in genes impacted at Central Nervous System and Immune Function sites.

METHOD

Methylation analysis was performed on DNA collected from the blood of participants classified with either high or low lifetime ETV. Illumina®MethylationEPIC Beadchips (~850k CpG sites) were processed on the iScan System to examine whole-genome methylation differences. Differentially methylated CpG-sites between high (n ​= ​19) and low (n ​= ​13) groups were identified using linear regression with violence and substance abuse as model covariates. Gene ontology analysis was used to identify enrichment categories from probes annotated to the nearest gene.

RESULTS

A total of 595 probes (279 hypermethylated; 316 hypomethylated) annotated to 383 genes were considered differentially methylated in association with ETV. Males with high ETV showed elevated methylation in several signaling pathways but were most impacted at Central Nervous System and Immune Function affiliated sites. Eight candidate genes were identified that play important biological roles in stress response to violence with HDAC4 (10%), NR4A3 (11%), NR4A2 (12%), DSCAML1(12%), and ELAVL3 (13%) exhibiting higher levels in the low ETV group and DLGAP1 (10%), SHANK2 (10%), and NRG1(11%) having increased methylation in the high ETV group. These findings suggest that individuals subjected to high ETV may be at risk for poor health outcomes that have not been reported previously.

Reproductive health needs of recently incarcerated youth during community reentry: a systematic review

BACKGROUND

Youth involved in the juvenile justice system have high reproductive health needs and, on exiting detention, face the challenging transition of reentry. We conducted a systematic literature review to describe what is known about youths' reproductive health needs during community reentry after incarceration.

METHODS

We searched PubMed, CINAHL, Cochrane Library, and Google Scholar for articles containing key words with the concepts 'child or adolescent', 'incarcerated' and 'reentry'. In the search, we defined the concept of 'reentry' as within 1 month prior to release (to include interventions involving pre-release planning) and up to 18 months after release from incarceration.

RESULTS

Our search yielded 2187 articles. After applying all exclusion criteria, 14 articles on reproductive health remained for extraction. The articles provided data on the following aspects of youths' reproductive health: frequency of condom use (eight articles), sexual risk behaviours other than lack of condom use (seven articles), and prevalence of sexually transmitted infections (three articles).

CONCLUSIONS

The literature on the reproductive health needs of youth undergoing reentry is extremely limited. Current intervention studies yield mixed but promising results and more intervention studies that address both pre-release reentry planning and the post-incarceration period are needed. Given incarcerated youths' well-documented reproductive health disparities compared with non-incarcerated adolescents, the identified gaps represent important opportunities for future research and programmatic emphasis.

Tough Choices: Exploring Decision-Making for Pregnancy Intentions and Prevention Among Girls in the Justice System

Despite California's declining teen pregnancy rate, teens in the juvenile justice system have higher rates than their nonincarcerated counterparts. This study explored domains that may shape decision-making for pregnancy prevention in this group. Twenty purposively selected female teens with a recent incarceration participated in hour-long semistructured interviews about their future plans, social networks, access to reproductive health services, and sexual behavior. Transcripts revealed that, contrary to literature, desire for unconditional love and lack of access to family planning services did not mediate decision-making. Lack of future planning, poor social support, and limited social mobility shaped youths' decisions to use contraceptives. Understanding this group's social location and the domains that inform decision-making for pregnancy intentions and prevention provides clues to help programs predict and serve this population's needs.

Physical Health, Medical Care Access, and Medical Insurance Coverage of Youth Returning Home After Incarceration: A Systematic Review

Youth reentry following incarceration is a subject of active health care policy innovation and debate. We systematically searched PubMed, CINAHL, Cochrane Library, and Google Scholar for research articles on physical health status or medical care access related to youth reentry (i.e., children and adolescents under 18 years of age). A total of 2,187 articles were identified in the search. After applying exclusion criteria, 10 articles remained. Those included covered general physical health (four articles), medical insurance coverage (five), noninsurance barriers to care and care utilization (five), and reentry youths' prioritization of needs (four). Despite vulnerable health status, the literature on youths' physical health status and medical care access during reentry is sparse, signifying a disconnect in research priorities. The findings suggest that intervention trials on youth reentry and health are needed and that that policy makers should be concerned with Medicaid policy reform.

Violence Exposure and Sexual Risk Behaviors for African American Adolescent Girls: The Protective Role of Natural Mentorship and Organizational Religious Involvement

African American adolescent girls are at increased risk of being exposed to community violence and being diagnosed with a sexually transmitted infection. Fewer studies, however, have examined the protective roles of natural mentorship and organizational religious involvement as potential moderators that could lessen the effects of violence exposure on health risk behavior. Data from 273 African American ninth grade girls were used to test hypothesized independent and moderated-moderation models. Results suggest that natural mentorship and religious involvement were protective for girls who reported at least one mentor and moderate to high levels of religious involvement. Our findings may be relevant for community stakeholders and organizations that directly interact with religious institutions and community programs that focus on outreach to African American adolescent girls.

Addressing adolescents' risk and protective factors related to risky behaviours: Findings from a school-based peer-education evaluation in the Western Cape

BACKGROUND

Peer-education programmes aim to bring about attitudinal and behavioural changes in their target audience. In the South African educational context, peer education is a favoured approach in dealing with issues such as HIV and AIDS, sexual decision-making and substance misuse. Given the reliance on peer-education programmes in the educational system, it is important to establish how well they are working. This study aims to assess the effect of an extensive, structured, time-limited, curriculum-based, peer-led educational programme on first-year high school learners in public schools in the Western Cape Province of South Africa.

METHOD

The curriculum called 'Listen Up' addresses issues such as supporting peers, sexual decision-making, healthy relationships, HIV risk, alcohol misuse and unwanted pregnancy in seven structured sessions. The programme targeted adolescents in Grade 8 growing up in what are considered to be risky environments in public schools in the Western Cape during 2012 and 2013. The intervention was evaluated based on 10 scales sourced from published literature related to the outcome indicators of future orientation, sensation-seeking, self-efficacy in sexual relations, HIV transmission knowledge, HIV prevention knowledge, HIV attitudes, sexual attitudes, decision-making, healthy relationships and social support. Descriptive statistics were used to analyse demographic and community characteristics and analyses of variance were used to detect differences between groups. The surveys were administered to a total of 7709 learners across three waves of the study in 27 peer intervention schools and eight control schools.

RESULTS

Immediately post intervention, statistically significant differences were noted for the intervention schools when compared to their baseline levels on measures of future orientation, self-efficacy in sexual relations, knowledge regarding HIV transmission, knowledge regarding HIV prevention and knowledge in terms of healthy relationships. Comparing baseline values with results collected between five and seven months post intervention, statistically significant results were noted for self-efficacy in sexual relations and knowledge regarding HIV transmission.

CONCLUSION

The findings of this study suggest that peer-education can improve adolescents' self-efficacy in sexual relations as well as knowledge regarding the transmission of HIV and therefore can contribute to the prevention of HIV transmission among adolescents.

Understanding Psychosocial and High-Risk Sexual Behaviors Among Detained Juveniles: A Descriptive Study Protocol

Background

African American women are disproportionately impacted by sexually transmitted infections (STIs), such as chlamydia and gonorrhea, which are known risk factors for human immunodeficiency virus (HIV) infection. STIs, particularly chlamydia and gonorrhea, are even more prevalent among young African American women with a juvenile detention history. The population with experiences with the criminal justice system has greater rates of STIs and is diagnosed more often with mental health issues, often related to sexual abuse or intimate partner violence, compared to peers who have not been detained by law enforcement. Psychosocial factors, especially those related to intimate relationships (ie, the imperativeness of being in a relationship and the power one has in their relationship), have emerged as important explanatory factors for acquiring STIs, including HIV, and a component of risk reduction interventions.

Objective

To investigate more comprehensively the relationship between psychosocial risk factors and STIs, including HIV, as it relates to reduction and prevention of these diseases. The long-term goal is to improve the effectiveness of evidence-based interventions with a major focus on intimate relationship dynamics.

Methods

This descriptive study surveys young women (ages 13-17) who have been detained (incarcerated) by a department of juvenile justice. In addition to being female and detained, eligibility criteria include being detained longer than 30 days and being free of cognitive impairments. This study will include young women from one juvenile detention center. The primary outcomes to be measured are STI knowledge, intimate relationship dynamics (ie, imperativeness and power), and high-risk sexual behaviors. High-risk sexual behaviors will be assessed using data extracted from health records.

Results

Preliminarily, we have received assent from 26 primarily young African American women. The majority of participants (81%) had inadequate knowledge about STIs, 52% perceived a lack of power in their relationship, 56% were fearful of negotiating condom use, and 60% were not comfortable refusing sex. Interestingly, a majority of participants (68%) did not perceive a relationship as imperative.

Conclusions

When enrollment and data collection are completed, it is expected that the primary outcome of intimate relationship dynamics (ie, imperativeness and power) will be associated with high-risk sexual behaviors and having an STI. Further, the findings are expected to provide guidance in developing a risk reduction intervention, for the population in which psychosocial factors related to intimate relationships will be central.

Health-Risk Behaviors and Dating Violence Victimization: An Examination of the Associated Risk Behaviors Among Detained Female Youth

There are many health-risk behaviors that may elevate the risk of adolescents engaging in teenage dating violence. The purpose of this investigation was to examine the health-risk behaviors that are associated with a sample of female juvenile offenders to identify the extent to which those behaviors contribute to dating violence. The survey assessed respondents' health-risk behaviors prior to incarceration, their perceptions of quality of life, post-incarceration expectations, psychosocial factors, and other social determinants. Results indicated youth exposure to dating violence, alcohol, drug, and risky sexual behaviors in the year prior to incarceration. These findings demonstrate the need to address teen dating violence with at-risk adolescents in addition to risky behaviors.

Sexual Risk Behavior and STI Contraction Among Young Women With Prior Juvenile Justice Involvement

Girls in the juvenile justice system are at increased risk for contracting HIV/AIDS. Sexual risk behavior was examined in 166 females with juvenile justice involvement who were followed from adolescence to young adulthood. Results indicated that childhood sexual abuse increased the incidence of unsafe sex during young adulthood, which was subsequently associated with contraction of a sexually transmitted infection (STI). Further, girls' comfort in talking with their partners about safer sex practices during adolescence moderated the association between childhood sexual abuse and unsafe sex, such that girls who had been sexually abused and were uncomfortable talking to their partners about safer sex during adolescence had an 8.5-fold increase in unsafe sex in young adulthood. The identification of behaviors amenable to intervention in the prevention of HIV/AIDS risk in this high-risk population is discussed.

Does gender matter? Exploring mental health recovery court legal and health outcomes

BACKGROUND

Based upon therapeutic justice principles, mental health courts use legal leverage to improve access and compliance to treatment for defendants who are mentally ill. Justice-involved women have a higher prevalence of mental illness than men, and it plays a greater role in their criminal behavior. Despite this, studies examining whether women respond differently than men to mental health courts are lacking. Study goals were to examine gender-related differences in mental health court participation, and in criminal justice, psychiatric and health-related outcomes.

METHODS

This study utilized a quasi-experimental pre-posttest design without a control group. The data were abstracted from administrative records of Kalamazoo Community Mental Health and Substance Abuse agency, the county jail and both county hospitals, 2008 through 2011. Generalized estimating equation regression was used to assess gender-differences in pre-post program outcomes (jail days, psychiatric and medical hospitalization days, emergency department visits) for the 30 women and 63 men with a final mental health court disposition.

RESULTS

Program-eligible females were more likely than males to become enrolled in mental health court. Otherwise they were similar on all measured program-participation characteristics: treatment compliance, WRAP participation and graduation rate. All participants showed significant reductions in emergency department visits, but women-completers had significantly steeper drops than males: from 6.7 emergency department visits to 1.3 for women, and from 4.1 to 2.4 for men. A similar gender pattern emerged with medical-hospitalization-days: from 2.2 medical hospital days down to 0.1 for women, and from 0.9 days up to 1.8 for men. While women had fewer psychiatric hospitalization days than men regardless of program involvement (2.5 and 4.6, respectively), both genders experienced fewer days after MHRC compared to before. Women and men showed equal gains from successful program completion in reduced jail days.

CONCLUSIONS

Despite similar participation characteristics, findings point to greater health gains by female compared to male participants, and to lower overall psychiatric acuity. Mental-health-court participation was associated with decreased psychiatric hospitalization days and emergency department visits. Successful program completion correlated to fewer jail days for both women and men.