How Does Incarcerating Young People Affect Their Adult Health Outcomes?

Per- and Polyfluoroalkyl Substance Exposure Risks in US Carceral Facilities, 2022

Objectives. To assess the US incarcerated population's risk of exposure to per- and polyfluoroalkyl substances (PFASs). Methods. We assessed how many of the 6118 US carceral facilities were located in the same hydrologic unit code watershed boundaries as known or likely locations of PFAS contamination. We conducted geospatial analyses on data aggregated from Environmental Protection Agency databases and a PFAS site tracker in 2022 to model the hydrologically feasible known and presumptive PFAS contamination sites for nearly 2 million incarcerated people. Results. Findings indicate that 5% (∼310) of US carceral facilities have at least 1 known source of PFAS contamination in the same watershed boundary and that it is at a higher elevation than the facility; also 47% (∼2285) have at least 1 presumptive source. A minimum of 990 000 people are incarcerated in these facilities, including at least 12 800 juveniles. Exposure risks faced by incarcerated youths are disproportionately underassessed. Conclusions. The long-term impacts from potential exposures to PFAS are preventable and exacerbate health inequities among incarcerated populations. Widespread public attention to PFASs can be parlayed into broader environmental monitoring for imprisoned people. (Am J Public Health. 2024;114(5):501-510. https://doi.org/10.2105/AJPH.2024.307571).

Health Service Utilization in Adolescents Following a First Arrest: The Role of Antisocial Behavior, Callous-Unemotional Traits, and Juvenile Justice System Processing

Previous research indicates that youth exhibiting antisocial behavior are at risk for utilizing a disproportionate amount of health services compared to youth without these problems. The present study investigates whether being processed by the juvenile justice system and showing callous-unemotional (CU) traits independently predict health service utilization (medical and mental health service use and out-of-home placement) over and above the severity of antisocial behavior across adolescence. A total of 766 participants who had been arrested for the first time in adolescence provided data at ten appointments over a period of seven years. Results showed that self-reported antisocial behavior at the time of arrest predicted increased use of most health service use types over the next seven years (i.e. medicine prescriptions, tests for sexually transmitted infections, mental health service appointments, and out-of-home placements). All except prescription medication use remained significant when controlling for justice system processing and CU traits. Further, justice system processing added significantly to the prediction of medical service appointments. Whereas CU traits were associated with mental health service appointments and out-of-home placements, these did not remain significant when controlling for severity of antisocial behavior. These findings are consistent with prior research documenting the health care costs of antisocial behavior.

Policy solutions to eliminate racial and ethnic child health disparities in the USA

Societal systems act individually and in combination to create and perpetuate structural racism through both policies and practices at the local, state, and federal levels, which, in turn, generate racial and ethnic health disparities. Both current and historical policy approaches across multiple sectors-including housing, employment, health insurance, immigration, and criminal legal-have the potential to affect child health equity. Such policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. Policy efforts that do not directly address structural racism will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism. In Paper 2 of this Series, we build on Paper 1's summary of existing disparities in health-care delivery and highlight policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improve the health of racially and ethnically minoritised children.

Voice of incarcerated male youths in Malawi's semi-urban prisons: a qualitative study

OBJECTIVE

Incarcerated male youths in Malawi's detention facilities face multiple threats to their health and well-being. The most common challenges are overcrowding, poor sanitation and a lack of access to basic needs such as adequate food, bedding and healthcare. In addition, youth are vulnerable to sexual abuse.

DESIGN

A qualitative approach using an exploratory study design was used to explore the experiences of incarcerated male youths in semi-urban prisons.

SETTING

Two semi-urban prisons in Malawi.

PARTICIPANTS

Three focus group discussions (each with six participants) with incarcerated youths aged 18 were conducted.

RESULTS

The following four themes emerged from the data: sexual violence perpetuated by other incarcerated persons; the need for sexual violence communication and prevention; trauma associated with incarceration and youth surviving prison life. The incarcerated male youths reported being given incentives such as extra food and adequate sleeping space in exchange for sexual favours with adult incarcerated people or incarcerated individuals with leadership positions. The victims of sexual abuse have had some difficulties reporting the incidences due to a non-existent reporting system for such matters to prison authorities.

CONCLUSIONS

This study reveals that the prison environment in Malawi is unsafe, particularly for incarcerated male youths who are at an increased risk of being victims of sexual violence. We recommend that the youths be separated from adults according to the Prison Rape Elimination Act standards. The prison officers should prevent incarcerated youth from having sight or physical contact with adult incarcerated people while in housing units. Policy-makers, prison authorities and researchers must safeguard and empower survivors of sexual violence in prisons.

Parents' Adverse and Positive Childhood Experiences and Offspring Involvement With the Criminal Legal System

Importance

Intergenerational cycles of adversity likely increase one's risk of criminal legal system involvement, yet associations with potential contributors, such as parents' adverse childhood experiences (ACEs) and positive childhood experiences (PCEs), have not been explored.

Objective

To investigate the association of parents' ACEs and PCEs with their adult children's involvement in US legal systems, from arrest to conviction.

Design, Setting, and Participants

The study team analyzed data from the Panel Study of Income Dynamics (PSID), a nationally representative cohort study of families in the US. PSID-2013 survey data were merged with the 2014 PSID Childhood Retrospective Circumstances Study (CRCS), collected May 2014 to January 2015, which asked adults aged 18 to 97 years to retrospectively report on their childhood experiences. Parents and their adult children were linked in the data set. Data were analyzed from October 2022 to September 2023.

Main Outcomes and Measures

The child arrest outcome was regressed on parents' ACE and PCE scores using logistic regression models. In addition, multinomial logistic regression models were used to assess the associations of parents' ACE and PCE scores with the number of times their child was arrested and convicted.

Results

Of 12 985 eligible individuals, 8072 completed the CRCS. Among CRCS participants, there were 1854 eligible parent-child dyads (ie, parents and their adult children) that formed the analytic sample. The mean (SD) age of offspring at the time of CRCS completion was 38.5 (10.9) years, and 1076 offspring (51.3%) were female. Having 4 or more parental ACEs was associated with 1.91-fold (95% CI, 1.14-3.22) higher adjusted odds of arrest before age 26 and 3.22-fold (95% CI, 1.62-6.40) higher adjusted odds of conviction before age 26 years, compared with children of parents without ACEs. These associations persisted after controlling for parental PCEs.

Conclusions and Relevance

In this nationally representative study, children of parents with higher ACEs were at greater risk of arrest during adolescence and young adulthood, even after controlling for parents' PCEs. Addressing and preventing childhood adversity through multigenerational life course approaches may help disrupt intergenerational pathways to the criminal legal system.

The Effect of a Group Physical Activity Program on Behavior of Incarcerated Youth

Behavioral health challenges are more prevalent in incarcerated youth than in the general youth population. Questions remain regarding whether physical activity programs can reduce behavioral health challenges in incarcerated youth. Data were available for 1,285 youths incarcerated between January 2017 and December 2018. The structured exercise program was implemented in January 2018. Primary outcomes were numbers of use of force (UoF) and of program modifications (PMs) indicative of delinquent behavior in pre- and post-exercise implementation periods. Rates per 1,000 person-days for UoF (10.0 in 2017 vs. 7.4 in 2018) and for PMs (36.7 vs. 22.9) were statistically different. For youths incarcerated both years, rates per 1,000 person-days for UoF (12.3 vs. 7.9), and for PMs (43.3 vs. 23.5) were statistically different. There was a reduction in behavior modifications in incarcerated youths after implementing the exercise program, but further studies are needed to confirm these results.

Racial disparities in youth pretrial detention: a retrospective cohort study grounded in critical race theory

BACKGROUND AND METHOD

Pretrial detention makes up 75% of juvenile detention admissions and contributes to the disproportionate contact of minoritized youth in the juvenile carceral system. Given that prior evidence largely examines differences between Black and white youth, this study expands research on disproportionate contact in the pretrial detention setting to Hispanic/Latinx, Indigenous, and Asian youth. With a sample of over 44,000 juvenile cases in a northwest state, we used a generalized linear mixed model to estimate the effect of individual level characteristics while accounting for the random effect of differences at the county level. Additionally, we utilized Critical Race Theory (CRT) in formulating our theoretical model and predictions and apply CRT in our analysis and discussion of our results. In doing so we hope to build upon its application in public health discourse for naming and deconstructing processes that lead to unjust social and health stratification.

RESULTS

After factoring in gender, age, crime severity, previous offenses, and variation between counties, our analyses show that Black, Hispanic/Latinx, and American Indian/Alaskan Native youth are more likely to experience pretrial detention than white youth. The likelihood of pretrial detention for Asian youth and for youth identified as "Other" or "Unknown" was not significantly different from white youth.

CONCLUSIONS

As the iatrogenic effects of detention are disproportionately imposed upon youth of color-particularly Black, Indigenous, and Hispanic/Latinx youth-the disparities present in our study reveal further evidence of institutional racism. In this way, we can see how this carceral process operates as a mechanism of racialized social stratification as put forth by CRT. Considering implications for policy or further research, persistent disparity highlights an enduring need for building or strengthening diversion programs and alternatives to the carceral system, with emphasis on those that are culturally responsive.

Old enough to offend but not to buy a hamster: the argument for raising the minimum age of criminal responsibility

The minimum age of criminal responsibility in Australia is 10 years. The topic of raising the age of criminal responsibility remains a fraught and challenging field of both study and thought. Despite overwhelming evidence to support an increase in the minimum age of criminal responsibility, there remains a resolute opposition in the majority of States in Australia that this age should be raised. However, the grounds for reconsidering the current position are indeed compelling. This paper expounds the persuasive arguments for raising the minimum age of criminal responsibility by examining the current scientific evidence and opinion. Considerations are explored and the relevant literature examined using the author's framework that decisions should be just, scientific, not racist, humane, cost-effective and generally not ludicrous. Principles for an alternative approach to criminalisation and for managing the harmful behaviour of children are then offered.

Criminal offense charges in women: A 10-year follow-up of an RCT of treatment foster care Oregon

OBJECTIVE

The prevention of delinquency can have long-term benefits for both the individual and society. Previous work has demonstrated positive effects of Treatment Foster Care Oregon (TFCO) on reducing delinquency across a 2-year period for adolescent females involved in the juvenile justice system. The present study examined whether the effects of TFCO are present across a 10-year period, and whether criminal offenses accrued in the juvenile justice system mediate the association between intervention condition and cumulative criminal offenses through emerging adulthood.

METHOD

The sample included 166 women (68% non-Hispanic White) who had been court mandated to out-of-home care as adolescents, randomly assigned to one of two interventions, and followed for an average of 10 years. Juvenile (< 18 years of age) and adult criminal records data were collected and coded for offense severity.

RESULTS

Analyses revealed a significant effect of the TFCO intervention on cumulative criminal offense charge severity across the 10-year follow-up period (β = -.15, p < .05). This effect was mediated by offense charges that occurred after the baseline assessment and prior to Age 18, as shown through a significant indirect effect, β = -.09, p < .05, suggesting the importance of reductions in juvenile delinquency on later criminal offending.

CONCLUSIONS

Intensive out-of-home interventions that reduce juvenile offenses for youth with chronic delinquency may have sustained effects on adult criminality. Implications for prevention programs for female adolescents are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

[Prison health care for juveniles who are incarcerated in France]

In France, on the 1^st march 2022, 656 underage persons are in prison. They have more psychiatric and substance use disorders compared to the juveniles in the general population. In prison, health care is organized according to three levels. A global and partnership approach is promoted. The main objectives are prevention, risk reduction and continuity of care.

Commercial Sexual Exploitation During Adolescence: A US-Based National Study of Adolescent to Adult Health

OBJECTIVES

National data on the health of children and adolescents exposed to commercial sexual exploitation (CSE) are lacking, during both adolescence and adulthood. Using nationally representative data, we examined the health of male and female adolescents in grades 7-12 who experienced CSE exposure and subsequent adult health outcomes and access to health care.

METHODS

Our retrospective cohort study used data from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health (1994-2008) to characterize relationships between CSE exposure before or during adolescence and health during adolescence and adulthood. The analytic sample included 10 918 adult participants aged 24-34 in Wave IV. We performed bivariate analyses, stratified by sex, to quantify the relationship between CSE exposure before or during adolescence and adolescent and adult health outcomes.

RESULTS

Four percent of participants reported having a CSE exposure before or during adolescence (5% of males, 3% of females). Factors associated with CSE exposure among adolescents included race/ethnicity, parental education level, previous abuse, same-sex romantic attractions, history of ever having run away from home, and substance use. During adolescence, exposure to CSE was associated with worse overall health, depressive symptoms, and suicidal thoughts for both males and females. In adulthood, adolescent CSE exposure was associated with depression among males and functional limitations among females. A higher percentage of males with CSE exposure before or during adolescence, compared with their non-CSE-exposed peers, used the emergency department as their usual source of care during adulthood.

CONCLUSIONS

CSE exposure before or during adolescence was associated with poor adolescent and adult health outcomes and health care access. Observed differences between males and females warrant further exploration.

Mental Disorders Into Adulthood Among Adolescents Placed in Residential Care: A Prospective 10-Year Follow-up Study

Background

Child welfare and juvenile justice placed youths show high levels of psychosocial burden and high rates of mental disorders. It remains unclear how mental disorders develop into adulthood in these populations. The aim was to present the rates of mental disorders in adolescence and adulthood in child welfare and juvenile justice samples and to examine their mental health trajectories from adolescence into adulthood.

Methods

Seventy adolescents in shared residential care, placed by child welfare (n = 52, mean age = 15 years) or juvenile justice (n = 18, mean age = 17 years) authorities, were followed up into adulthood (child welfare: mean age = 25 years; juvenile justice: mean age = 27 years). Mental disorders were assessed based on the International Classification of Diseases 10th Revision diagnoses at baseline and at follow-up. Epidemiological information on mental disorders was presented for each group. Bivariate correlations and structural equation modeling for the relationship of mental disorders were performed.

Results

In the total sample, prevalence rates of 73% and 86% for any mental disorder were found in adolescence (child welfare: 70%; juvenile justice: 83%) and adulthood (child welfare: 83%; juvenile justice: 94%) respectively. General psychopathology was found to be stable from adolescence into adulthood in both samples.

Conclusions

Our findings showed high prevalence rates and a high stability of general psychopathology into adulthood among child welfare and juvenile justice adolescents in Swiss residential care. Therefore, continuity of mental health care and well-prepared transitions into adulthood for such individuals is highly warranted.

Longitudinal evidence on adolescent social network position and cardiometabolic risk in adulthood

RATIONALE

Despite the importance of the role of social networks in health, few studies have examined the relationship between adolescent social network position and adult health.

OBJECTIVE

This study examines whether several dimensions of one's social network position in adolescence is associated with cardiometabolic risk in adulthood among U.S. adolescents. This study also explores the mechanisms that undergird the relationship between adolescents' network position and their later-life health.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health (N = 9517), this study uses ordinary least squares regression models with school fixed effects. Three measures of adolescent social network position, including popularity, Bonacich centrality, and social isolation, were sociometrically assessed in schools. Cardiometabolic risk in adulthood was based on 12 biomarkers covering four domains of physiological systems.

RESULTS

All three measures of adolescent network position were associated with adult cardiometabolic risk even after controlling for sociodemographic and family-level covariates, as well as school fixed effects. Controlling for adolescent characteristics attenuated the associations for popularity, Bonacich centrality, and isolation by 31%, 58%, and 26%, respectively, which rendered the associations for Bonacich centrality statistically nonsignificant. Adult health behaviors were the most consistent mediator for popularity and isolation, whereas adult socioeconomic attainment explained part of the association for popularity. In contrast, adult social integration did not play a mediating role. Simultaneously controlling for all proposed mechanism variables explained 17% and 18% of the associations for popularity and isolation, respectively.

CONCLUSIONS

Findings of this study suggest that social network position during adolescence has enduring consequences for cardiometabolic risk in adulthood. A combination of behavioral and human capital pathways explains part of the associations, though they appear to operate differently for distinct network position measures.

Applying a Health Development Lens to Canada's Youth Justice Minimum Age Law

OBJECTIVES

We applied a Life Course Health Development (LCHD) framework to examine experts' views on Canada's youth justice minimum age law of 12, which excludes children aged 11 and under from the youth justice system.

METHODS

We interviewed 21 experts across Canada to understand their views on Canada's youth justice minimum age of 12. The 7 principles of the LCHD model (health development, unfolding, complexity, timing, plasticity, thriving, harmony) were used as a guiding framework for qualitative data analysis to understand the extent to which Canada's approach aligns with developmental science.

RESULTS

Although the LCHD framework was not directly discussed in the interviews, the 7 LCHD framework concepts emerged in the analyses and correlated with 7 justice principles, which we refer to as "LCHD Child Justice Principles." Child involvement in the youth justice system was considered to be developmentally inappropriate, with alternative systems and approaches regarded as better suited to support children and address root causes of disruptive behaviors, so that all children could reach their potential and thrive.

CONCLUSIONS

Canada's approach to its minimum age law aligns with the LCHD framework, indicating that Canada's approach adheres to concepts of developmental science. Intentionally applying LCHD-based interventions may be useful in reducing law enforcement contact of adolescents in Canada, and of children and adolescents in the United States, which currently lacks a minimum age law.

Piloting an Evidence-Based Assessment Protocol for Incarcerated Adolescents

Although evidence-based assessment is considered an essential component of evidence-based practice, few adolescents have access to evidence-based assessment. Despite experiencing high rates of mental health disorders, incarcerated justice-involved adolescents are rarely able to access evidence-based psychiatric care. In this article, we discuss the components of an evidence-based assessment protocol designed and piloted with incarcerated adolescents involved in Rhode Island's juvenile justice system. In particular, we describe the components of our evidence-based protocol, ways in which evidence-based assessment may need to be modified when working with this population, and discuss policy and clinical implications relevant to increasing access to evidence-based assessment among incarcerated adolescents.

Race-gender variation in the relationship between arrest history and poor health from adolescence to adulthood

OBJECTIVE

The objective of this study is to examine how criminal justice involvement, specifically arrests, shapes health by race-gender status and age for Black, Latinx, and White men and women from adolescence to adulthood.

METHOD

Data were from sixteen waves (1997-2013) of data of National Longitudinal Survey of Youth 1997 cohort (N = 7,674). Respondents were 12-16 years during the first wave of the survey. Multivariate logistic regression with interactions were used to determine how age and race-gender status shape the association between poor health and arrests over time.

RESULTS

With the exception of Black men, arrest history is positively associated with the probability of poor health and this relationship strengthens with age. Arrests have the least detrimental impact on the health of Black men. For those without an arrest history, the probability of poor health also increases with age, but with a less steep incline over time than those who have been arrested. Overall, women who have been arrested, regardless of race, have the worst health prospects.

CONCLUSIONS

A history of arrest is important for health from adolescence to adulthood and varies by race-gender status and age. Those without arrests in their backgrounds enjoy better health at both younger and older ages. For those who experience arrest, they generally report poorer health from adolescence into adulthood. One exception is Black men for whom those with an arrest history report the lowest probability of poor health, compared to Black women, Latinx men, Latinx women, White men, and White women.

Police Stops and Adolescent Substance Use: Findings From the United Kingdom Millennium Cohort Study

PURPOSE

The aim of this study is to investigate associations between police stops and adolescent substance use among a large, representative sample of adolescents in the United Kingdom (UK).

METHODS

Data from the three most recent sweeps of the UK Millennium Cohort Study, a nationally representative contemporary birth cohort of children born in the UK between September 2000 and January 2002, were analyzed in 2021 (N = 10,345). Lifetime police stops are assessed at age 14 (Sweep 6, 2015) and a diverse set of adolescent substance use behaviors are assessed at age 17 (Sweep 7, 2018). Weights are used to account for sample design and multiple imputation for missing data.

RESULTS

Youth experiencing police stops by the age of 14 (14.72%) reported significantly higher engagement in substance use behaviors at age 17, including frequent binge drinking (adjusted relative risk ratio [ARRR] = 3.56, confidence interval [CI] = 2.80-4.03), cigarette use (ARRR = 3.97, CI = 3.26-4.84), e-cigarette use (ARRR = 2.22, CI = 1.69-2.93), cannabis use (ARRR = 3.63, CI = 2.88-4.57), and illicit drug use (adjusted incidence rate ratio = 3.06, CI = 2.45-3.81). Ancillary analyses revealed that findings linking police stops to substance use emerge across distinct stop features (e.g., questioned vs. warned), following adjustment for substance use at age 14, and when examining substance use initiation after the age of 14.

CONCLUSIONS

Police officers should be trained to effectively communicate and interact with youth to mitigate adverse sequelae of stops. Youth may also benefit from mental health and substance use screenings as well as counseling care following these events.

Mental disorders among adults formerly in out-of-home care: a systematic review and meta-analysis of longitudinal studies

While children and adolescents placed in child welfare or juvenile justice out-of-home care show higher prevalence rates of mental disorders compared to the general population, it remains unclear whether this pattern persists into adulthood. A quantitative synthesis of existing studies is lacking. The aim of this meta-analysis was to estimate the prevalence rates for mental disorders among adults with a foster or residential child welfare or juvenile justice care history, comparing them where possible to rates among the general population. PubMed, PsycInfo, EMBASE, and Web of Science were systematically searched for epidemiological studies published up to 28 October 2020. Nineteen studies, totaling 604,257 participants, met our inclusion criteria. Random-effects models were used for prevalence rates and odds ratios (OR) of mental disorders, and study quality was rated. A prevalence rate of 30% [95% CI (23.36, 37.36)] for any mental disorder in adults with a child welfare care history was found (3-17% for specific disorders). A prevalence rate of 45% [95% CI (42.38, 47.38)] for any mental disorder was found in adults with a juvenile justice care history (6-66% for specific disorders). For out-of-home placement history, adult mental disorders were significantly higher than in the general population (OR = 1.33-2.76). Studies differed in terms of methodology and the disorder groups considered, so heterogeneity between effect sizes ranged from low to high. Our findings suggest that the high risk that mental health issues will persist in adults with an out-of-home placement history needs to be taken seriously in the transition from adolescence to adulthood. The care systems involved need to collaborate and to be aware of these risks.

Mental and physical health problems before and after detention: A matched cohort study

Background

Individuals with poor health are largely overrepresented in prison populations. However, it remains unclear whether their poor health status already exists prior to their detention or reflects an effect of detention. We examined the health of detainees in the year before and after their detention and compared this with the health of matched non-detainees.

Methods

In this matched cohort study, we linked national data on all persons detained in the Netherlands in 2014/2015 to electronic health records (EHR's) of a representative sample of general practitioners in the Netherlands. Participants include 952 detained persons and 4760 matched non-detained persons (matched on age, sex and general practice). Prevalence rates of health problems in the year before and after detention and odds ratios with 95% confidence intervals were calculated. Rates for a variety of physical and mental health problems are presented.

Findings

Detainees and matched controls differed statistically significant in their pre-detention health status. Compared with controls, male detainees were more likely to report psychological (odds ratio [OR] 3·64 [95% CI 3·11–4·26]), social (1·96 [1·46–2·64]), neurological (1·34 [1·02–1·76]), digestive (1·23 [1·02–1·49]), genital system-related (1·36 [1·07–1·72]), and unspecified health problems (1·32 [1·10–1·59]) in the year before their detention. For example, 43·7% of detainees and 17·6% of controls reported psychological problems in this pre-detention year. To some extent these pre-detention health differences were related to socioeconomic differences. Nevertheless, after taking these characteristics into account, a number of pre-detention health differences between detainees and controls remained statistically significant. No statistically significant changes in prevalence rates from pre- to post-detention and no differences in the levels of change across detainees and controls were observed. For female detainees a similar pattern was found.

Interpretation

People who experience detention have high and complex health needs both pre- and post-detention. While this study did not show a health deteriorating effect of detention, it also did not show a health improving effect. This latter finding may indicate a missed opportunity for health care services to address detainees’ health, especially since persons entering detention have elevated health problems. Knowledge on detainees’ specific health problems may help health care providers in prisons and in the community to adequately address the health care needs of this vulnerable group.

Funding

None.

Unjust: the health records of youth with personal/family justice involvement in a large pediatric health system

BACKGROUND

Mass incarceration has had an undeniable toll on childhood poverty and inequality, however, little is known about the consequences on pediatric health. The purpose of this study was to identify and describe the health of pediatric patients with probable personal or family history involvement with the correctional system.

METHODS

A descriptive study was conducted using electronic health record data of 2.3 million youth (ages 0-21 years) who received care in a large Midwestern hospital-based institution from February 2006-2020. We employed a correctional-related keyword search (e.g. jail, prison, probation, parole) to locate youth with probable personal or family history involvement. Health characteristics were measured as clinician diagnostic codes.

RESULTS

Two percent of the total pediatric population had a correctional keyword in the medical chart (N = 51,855). This 2% made up 66% of all patients with cannabis-related diagnoses, 52% of all patients with trauma-related diagnoses, 48% of all stress-related diagnoses, 38% of all patients with psychotic disorder diagnoses, and 33% of all suicidal-related disorders within this institution's electronic health record database - among other highly concerning findings.

CONCLUSIONS

We captured an alarming health profile that warrants further investigation and validation methods to better address the gaps in our clinical understanding of youth with personal or family history involvement with the correctional system. We can do better in identifying, and supporting families affected by the correctional system.

Reimagining Youth Justice: How the Dual Crises of COVID-19 and Racial Injustice Inform Judicial Policymaking and Reform

The COVID-19 pandemic and the rejuvenated movement for racial justice in 2020 have presented an opportunity to reimagine the roles, practices, and policies of juvenile and family court systems actors. In order to capture contemporary ideas about judicial practice and policy reforms, semi-structured interviews were conducted with Hon. Edwina Mendelson, Deputy Chief Administrative Judge for the Office of Justice Initiatives in New York State, and Hon. Steven Teske, Chief Judge of the Juvenile Court of Clayton County, Georgia. These interviews yielded several recommendations for judicial reform in youth justice (e.g., implement court-wide procedural justice practices, improve accessibility using technology). These recommendations can be used by systems actors across the country, particularly those interested in adapting their courtroom practices for a post-pandemic world.

Undoing resilience: immigrant status and poor health following incarceration

BACKGROUND

In the United States, foreign-born persons often have better health outcomes than their native-born peers, despite exposure to adversity. Nevertheless, it is unclear whether this pattern extends to the consequences of life events, such as incarceration, that separate immigrants from their supportive networks and increase exposure to adversity. Accordingly, using four waves of data from the National Longitudinal Study of Adolescent to Adult Health, hierarchical generalized linear models were used to examine within-individual changes in self-rated health following first incarceration (N = 31,202 person-waves).

RESULTS

The results showed that incarceration was associated with modest health declines that were similar in magnitude for immigrant and native-born persons. Supplemental analyses revealed that these effects did not vary by immigrant race or ethnicity, or by age at immigration. The only exception was for immigrants from low- and middle-income countries, who were marginally less likely to experience health declines following incarceration.

CONCLUSIONS

In general, incarceration appears to be similarly health damaging for immigrants and non-immigrants. These findings raise important questions about how incarceration is linked to health declines for foreign- and native-born populations and emphasize the importance of access to healthcare for individuals released from correctional facilities. More research is needed, however, to further examine the cumulative impacts of incarceration on immigrants' health across the life course, and to assess a broader spectrum of health outcomes.

Youth Reentry from Prison and Family Violence Perpetration: the Salience of Family Dynamics

The central role of family within the process of juvenile reentry from a term of incarceration has been well documented by researchers and practitioners alike. However, family violence among previously incarcerated youth remains alarmingly high across the United States. Drawing from differential coercion and social support theory, we examine how family dynamics may simultaneously promote and/or inhibit family violence perpetration among youth undergoing the process of reentry. Four waves of panel data from the male-only youth subsample of the Serious and Violent Offender Reentry Initiative are analyzed using a series of dynamic panel data models. Findings demonstrate that both pre- and post-release levels of family conflict are significantly associated with increased family violence during reintegration. Mechanisms of family support, however, are not associated with post-release family violence. Results from this study highlight the salience of family conflict in understanding family violence perpetration among recently released juveniles and their families.

Effectiveness of an Individual Cognitive-Behavioral Intervention for Serious, Young Male Violent Offenders: Randomized Controlled Study With Twenty-Four-Month Follow-Up

Background: Psychological recidivism-reducing interventions with serious, young violent offenders in residential care have unsatisfactory effects. We tested if a complementary individual cognitive behavioral therapy (iCBT) intervention focusing problem-solving, cognitive self-control, and relapse prevention reduces criminal recidivism beyond usual institutional care encompassing interventions such as social skills training and prosocial modeling (treatment-as-usual; TAU). Method: We consecutively approached 115 eligible serious, male violent crime offenders in five residential treatment homes run by the Swedish National Board of Institutional Care. Eighty-one (70%) 16 to 21-year-old youth at medium-high violent recidivism risk were included and randomized to an individualized 15 to 20-session CBT intervention plus TAU (n = 38) or to TAU-only (n = 43), 4-6 months before release to the community. Participants were assessed pre- and post-treatment, at 12 months (self-reported aggressive behavior, reconvictions) and 24 months (reconvictions) after release. Intent-to-treat analyses were applied. Results: The violent reconviction rate was slightly higher for iCBT+TAU vs. TAU-only youth at 12 months (34 vs. 23%, d = 0.30, 95% CI: -0.24 to 0.84) and 24 months following release (50 vs. 40%, d = 0.23, 95% CI: -0.25 to 0.72), but neither of these differences were significant. Cox regression modeling also suggested non-significantly, negligibly to slightly more violent, and any criminal recidivism in iCBT+TAU vs. TAU-only youth during the entire follow-up. Further, we found no significant between-group differences in conduct problems, aggression, and antisocial cognitions, although both iCBT+TAU and TAU-only participants reported small to large within-group reductions across outcome measures at post-treatment. Finally, the 12-month follow-up suggested marginally more DSM-5 Conduct Disorder (CD) symptoms of "aggression to people and animals" in iCBT+TAU vs. TAU-only youth (d = 0.10, 95% CI: -0.40 to 0.60) although this difference was not significant. Conclusion: We found no additive effect of individual CBT beyond group-based TAU in residential psychological treatment for serious, young male violent offenders. Limited sample size and substantial treatment dropout reduced the robustness of intent-to-treat effect estimates. We discuss the possible impact of treatment dose and integrity, participant retention, and TAU quality.

Invisible women: correctional facilities for women across Canada and proximity to maternity services

Purpose

This paper aims to describe the process to create an inventory of the facilities in Canada designated to incarcerate women and girls, health service responsibility by facility, facility proximity to hospitals with maternity services and residential programmes for mothers and children to stay together. This paper creates the inventory to support health researchers, prison rights advocates and policymakers to identify, analyse and respond to sex and gender differences in health and access to health services in prisons.

Design/methodology/approach

In spring 2019, this study conducted an environmental scan to create an inventory of every facility in Canada designated for the incarceration of girls and women, including remand/pretrial custody, immigration detention, youth facilities and for provincial and federal sentences.

Findings

There are 72 facilities in the inventory. In most, women are co-located with men. Responsibility for health varies by jurisdiction. Few sites have mother-child programmes. Distance to maternity services varies from 1 to 132 km.

Research limitations/implications

This paper did not include police lock-up, courthouse cells or involuntary psychiatric units in the inventory. Information is unavailable regarding trans and non-binary persons, a priority for future work. Access to maternity hospital services is but one critical question regarding reproductive care. Maintenance of the database is challenging.

Originality/value

Incarcerated women are an invisible population. The inventory is the first of its kind and is a useful tool to support sex and gender and health research across jurisdictions.

What explains the concentration of off-premise alcohol outlets in Black neighborhoods?

INTRODUCTION

Greater availability of commercial alcohol is associated with increased alcohol use and related public health problems. Greater alcohol outlet density, a marker of alcohol availability, is associated with poorer and predominantly minority neighborhoods. However, poorer populations, African Americans, and Latinxs report using less alcohol compared to Whites and wealthier groups. We consider the role of structural racism in the social ecology of alcohol availability. Specifically we examine racist urban land use practices in the USA which became codified in the 1930s through Federal Home Owner Lending Corporation (HOLC) designations for assigning parcel values, known as "redlining." Redlining demarcated low-density residential zones for wealthy Whites which excluded poor and non-White people as well as certain businesses, including alcohol retailers. We assessed the impacts of historic redlining on present day risks for exposure to retail alcohol availability in urban Northern California.

METHODS

For six contiguous and demographically diverse Northern California cities we obtained digital renderings of HOLC maps (1937) which demarcated exclusions of people and businesses for 119 neighborhood areas across four land valuation zones. We then identified the most prevalent HOLC rating for each of 520 current Census block groups in the six cities, including a residual category for areas not rated by HOLC. We geolocated all current (2016) off-premise alcohol sales outlets operating in the six cities (N = 401). We used Bayesian spatial Poisson models to relate current alcohol outlet densities and Census-based estimates of neighborhood characteristics to historic HOLC classifications.

RESULTS

Spatial Poisson analyses found far greater contemporary off-premise outlet densities in the lowest-valued HOLC zones than in the highest (median relative rate [RR] 9.6, 95% CI 4.8-22.1). The lowest-valued HOLC zones were also characterized by far higher current percentages of both Black residents (RR 30.4, 95% CI 17.0-54.6) and Hispanic residents (RR 9.7, 95% CI 7.2-12.9).

CONCLUSIONS

Present day risks for exposure to retail alcohol availability were delimited by historic exclusionary land use practices. Current inequitable health risks may be founded on racist spatial projects of past decades.

Health Needs of Youth in Detention With Limited Justice Involvement

Although incarcerated youth (i.e., youth sentenced to secure custody) have high health needs, the health of detained youth with limited justice involvement remains poorly understood. Between September 2018 and February 2019, social workers from the Los Angeles County Whole Person Care Juvenile Reentry Aftercare Program (WPC) assessed the health and social needs of youth in pre-trial detention. We partnered with the WPC team to analyze assessments completed by 83 youth participants. Youth were on average 16 years old, most (83%) identified as male, and all were from racial or ethnic minority groups. Participants reported high behavioral health needs, including a high prevalence of prior suicide attempts (16%) and history of substance use (81%). Participants demonstrated a pattern of crisis healthcare utilization. Youth also indicated areas of strength, including personal positive traits, engagement in extracurricular activities, educational achievements, and having multiple sources of social support. The majority of youth (74%) desired vocational training and nearly all (94 %) wanted to return to school after release. Overall, the findings indicate that detained youth with limited involvement in the justice system are a resilient group that have notably higher health risk than same-age peers, signifying a critical opportunity for intervention.

Estimating the influence of adolescent delinquent behavior on adult health using sibling fixed effects

Despite the well-established link between juvenile delinquency and socioeconomic attainment in adulthood, less is known about whether engagement in delinquent behavior during adolescence shapes adult health outcomes. This study examines the association between juvenile delinquency and adult physical and mental health, and whether this association is confounded by unobserved family heterogeneity. Moreover, this study explores the potential underlying mechanisms through which juvenile delinquency shapes adult physical and mental health. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) 1994-1995 (Wave 1) and 2007-2008 (Wave 4), we adopted a sibling fixed effect approach to account for genetic factors, family environment, and childhood social contexts such as school and neighborhood effects. The conventional OLS results show that engagement in delinquent behavior during adolescence strongly predicts higher levels of Framingham cardiovascular disease (CVD) risk score and depressive symptoms in adulthood. Once we account for family-specific heterogeneity, however, the point estimates of the associations of delinquency with CVD risk score and depressive symptoms are attenuated by 33% and 45%, respectively. Despite this attenuation, the association of juvenile delinquency with adult health is robust: a one standard-deviation increase in juvenile delinquency is associated with approximately 8 and 6 percent of one standard-deviation increases in CVD risk and depressive symptoms, respectively. Our mediation analyses suggest that a combination of several mediating pathways jointly explain the association between juvenile delinquency with adult health. The most consistent and significant mediating pathways connecting juvenile delinquency to both physical and mental health included disruption in student-teacher relationship, smoking, criminal justice contact, and educational attainment. Moreover, while binge drinking explained part of the association between delinquency and CVD risk score, student-friend relationship partially mediated the association with depression.

DOES THE TIMING OF INCARCERATION IMPACT THE TIMING AND DURATION OF HOMELESSNESS? EVIDENCE FROM "THE TRANSITIONS TO HOUSING" STUDY

Compared to their non-homeless peers, chronically homeless adults are much more likely to have a history of incarceration. In turn, homelessness is associated with increased morbidity, lack of access to adequate healthcare services, and decreased life expectancy. This study investigates whether age at first incarceration is associated with age at first homeless experience and with lifetime duration of literal homelessness. Study participants are homeless adults entering permanent supportive housing (PSH) in Los Angeles County, California, that have experienced incarceration prior to their first experience of homelessness (n=230). Multivariate linear regressions were conducted to determine association between age at first incarceration with: 1) age at first literal homelessness and 2) lifetime duration of literal homelessness. Results indicate that incarceration as a juvenile and young adult is significantly associated with earlier literal homelessness experiences and may be associated with longer durations of literal homelessness, for adults entering PSH. Moreover, women incarcerated as juveniles and entering PSH first experienced literal homelessness earlier than comparable men. Our findings suggest the need for long-term supportive services for persons incarcerated before 25 years old, especially for women. Moreover, these findings refine the working knowledge that prior incarceration increases risk for prolonged homelessness and can help agencies complete more accurate risk assessments.

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.

Achieving Justice for Girls in the Juvenile Justice System

Female involvement in the juvenile justice system has steadily increased in the United States over the past three decades. During this time, as male arrests have declined, female arrests have increased. Although many social workers have responded to these trends with a national call to identify and address the unique needs of these girls, we lack much high-quality research, including empirically supported interventions or programming to serve the needs of female youths involved in the justice system. This article provides a summary of the extant research that helps document the unique needs of these female youths and national policy efforts and practice considerations for social work practitioners. These needs and policy initiatives offer important opportunities for social workers to conduct research to improve the understanding of this population and also ways in which to provide services that address these youths' complex needs. The article concludes that these female youths-most of whom are not a danger to society-need services instead of involvement in the justice system.

Implications of Cannabis Legalization on Juvenile Justice Outcomes and Racial Disparities

INTRODUCTION

The objective of this study is to assess the changes in rates of juvenile cannabis criminal allegations and racial disparities in Oregon after legalization of cannabis (July 2015) for adults.

METHODS

This study included all allegations for cannabis-related offenses that occurred from January 2012 to September 2018 in Oregon. Negative binomial regression models were used to examine monthly cannabis allegation rates over time, and tested differences between youth of color and white youth, adjusting for age, gender, and month the allegation occurred. Analysis was conducted in January-March 2019.

RESULTS

Cannabis allegation rates increased 28% among all youth and 32% among cannabis-using youth after legalization. Rates of allegations were highest for American Indian/Alaska Native and black youth. Rates for black youth were double that of whites before legalization, and this disparity decreased after legalization. For American Indian/Alaska Native youth, rates were higher than whites before legalization, and this disparity remained unchanged.

CONCLUSIONS

Adult cannabis legalization in Oregon was associated with increased juvenile cannabis allegations; increases are not explained by changes in underage cannabis use. Relative disparities decreased for black youth but remained unchanged for American Indian/Alaska Native youth. Changing regulations following adult cannabis legalization could have unintended negative impacts on youth.

Parent and Provider Perspectives on Recently Incarcerated Youths' Access to Healthcare During Community Reentry

Incarcerated youth have numerous healthcare needs, yet access to healthcare following community reentry is limited. Healthcare and juvenile justice providers, along with parents, strongly influence access to care for youth undergoing reentry. However, their perspectives are often missing from the literature. We examined parent and provider perspectives on youths' access to healthcare during community reentry. We conducted 72 longitudinal interviews with parents of youth undergoing reentry (n= 34 parents) and cross-sectional interviews with health and juvenile justice providers (n=20 providers). We performed inductive analysis of interview transcripts to identify the major themes related to access to healthcare during reentry. Respondents identified key leverage points that influence access to healthcare along the spectrum of individual, community, and policy-level factors. Parent and provider perspectives demonstrated substantial overlap, strongly concurring on the essential role of parents in linking youth to care and the external factors that limit parents' ability to connect youth to care. However, providers discussed parents not buying-in to treatment plans as a barrier to care, and parents uniquely described feeling powerless when their children were not motivated to receive care. Parents and providers agreed on priority solutions for improving care access during reentry. Immediate solutions centered on: 1) increasing reliability and continuity of providers, 2) providing free or low-cost transportation to healthcare visits, and 3) eliminating gaps in Medicaid coverage post-incarceration. Findings also signal the broader need to pursue strategies that increase family engagement in healthcare during reentry. In doing so, health and juvenile justice providers can partner with parents to overcome barriers to healthcare for youth during reentry.

Association of Childhood History of Parental Incarceration and Juvenile Justice Involvement With Mental Health in Early Adulthood

IMPORTANCE

Young adults with a childhood history of parental incarceration (PI) or juvenile justice involvement (JJI) are more likely to have worse mental health outcomes than their peers. However, the association between mental health and exposure to both PI and JJI (PI plus JJI) is unclear.

OBJECTIVE

To determine the association of PI plus JJI exposure with mental health outcomes in young adulthood.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional study of the US National Longitudinal Survey of Adolescent to Adult Health was conducted to examine the associations between PI, JJI, and PI plus JJI and mental health outcomes (ie, depression, anxiety, posttraumatic stress disorder, suicidal ideation, and mental health counseling). In-home interviews were conducted of 13 083 participants; 704 participants with PI after age 18 years were excluded, and 12 379 participants formed the analysis sample. Participants were in grades 7 to 12 in 1994 to 1995 and were ages 24 to 32 years at follow-up in 2008. Data analysis was completed in 2019.

EXPOSURES

Parental incarceration, JJI, or PI plus JJI before age 18 years.

MAIN OUTCOMES AND MEASURES

Mental health outcomes in early adulthood (ages 24-32 years). The analysis included multivariable logistic regression models; accounted for individual, family, and geographic-level factors; and generated adjusted odds ratios.

RESULTS

Among 13 083 participants (6962 female; weighted proportion, 49.6%) with a mean age at wave 1 of 15.4 years (95% CI, 15.2-15.7 years), 10 499 (80.2%) did not have a history of PI or JJI, 1247 (9.1%) had childhood PI, 704 (5.2%) had PI after age 18 years, 492 (4.5%) had JJI only, and 141 (1.2%) had PI plus JJI. Sociodemographic characteristics varied by exposure. Exposure to both PI and JJI was associated with a greater risk of depression (adjusted odds ratio, 2.80; 95% CI, 1.60-4.90), anxiety (adjusted odds ratio, 1.89; 95% CI, 1.08-3.31), and posttraumatic stress disorder (adjusted odds ratio, 2.92; 95% CI, 1.09-7.82) compared with peers with neither exposure. Exposure to both PI and JJI did not have an additive association with mental health beyond PI or JJI alone.

CONCLUSIONS AND RELEVANCE

This study suggests that exposure to the criminal justice system during childhood places individuals at risk for poor mental health outcomes in early adulthood. Clinical, advocacy, and policy efforts that prioritize reducing the impact of the US criminal justice system on children may yield substantive improvements in the mental well-being of those individuals as adults.

The Impact of Racism on Child and Adolescent Health

The American Academy of Pediatrics is committed to addressing the factors that affect child and adolescent health with a focus on issues that may leave some children more vulnerable than others. Racism is a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families. Although progress has been made toward racial equality and equity, the evidence to support the continued negative impact of racism on health and well-being through implicit and explicit biases, institutional structures, and interpersonal relationships is clear. The objective of this policy statement is to provide an evidence-based document focused on the role of racism in child and adolescent development and health outcomes. By acknowledging the role of racism in child and adolescent health, pediatricians and other pediatric health professionals will be able to proactively engage in strategies to optimize clinical care, workforce development, professional education, systems engagement, and research in a manner designed to reduce the health effects of structural, personally mediated, and internalized racism and improve the health and well-being of all children, adolescents, emerging adults, and their families.

Criminal Justice Involvement and Young Adult Health: The Role of Adolescent Health Risks and Stress

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.

What Is the Relationship Between Incarceration of Children and Adult Health Outcomes?

OBJECTIVE

We sought to quantify the association between child incarceration in the United States and subsequent adult health outcomes.

METHODS

We analyzed National Longitudinal Study of Adolescent to Adult Health data from 1727 adult (Wave IV) participants first incarcerated at age <25 years. Using chi-square tests and multivariate logistic regression models, we compared adult health outcomes (ie, mobility limitations, depressive symptoms, and suicidal thoughts) among those first incarcerated at age ≤14 years, 15 to 17 years, and 18 to 20 years, with those first incarcerated at 21 to 24 years as the reference group.

RESULTS

Of the 1727 participants, 105 (6.7%) were first incarcerated at age ≤14 years ("child incarceration category"), 315 (19.3%) were first incarcerated at 15 to 17 years, 696 (38.5%) were first incarcerated at 18 to 20 years, and 611 (35.6%) were first incarcerated at 21 to 24 years. Those first incarcerated as children (age ≤14 years) were disproportionately black or Hispanic compared with those first incarcerated at 15 to 24 years. Compared with first incarceration at age 21 to 24 years, child incarceration independently predicted adult mobility limitations (adjusted odds ratio [OR], 3.74; P = .001), adult depression (OR, 1.98; P = .034), and adult suicidal thoughts (OR, 4.47; P = .005).

CONCLUSIONS

Child incarceration displays even wider sociodemographic disparities than incarceration generally and is associated with even worse adult physical and mental health outcomes.

Exploring Mental Health and Substance use Treatment Needs of Commercially Sexually Exploited Youth Participating in a Specialty Juvenile Court

The study sought to: (1) describe the mental health and substance use profiles among participants of a specialty trafficking court program (the Succeed Though Achievement and Resilience Court); (2) describe youths' mental health and substance use treatment prior to participating in the program; and (3) examine whether abuse influences report of mental health problems and/or substance use. Retrospective case review of court files was performed on commercially sexually exploited youth who volunteered to participate in the court from 2012 to 2014 (N = 184). All participants were female. Mental health problems and report of substance use was high among this population. Substance use differed at statistically significant levels between youth with a documented abuse history compared to those with no abuse history. Substance use also differed by report of mental health problems. Unexpected findings included the high rate of hospitalization for mental health problems and relatively low substance use treatment prior to STAR Court participation. Opportunities for improvement in critical points of contact to identify commercially sexually exploited youth and address their health needs are discussed.

Families and the Juvenile Justice System: Considerations for Family-Based Interventions

We conducted focus groups with defense lawyers, clinicians, and education advocates to gather their perspectives on families' experiences with the juvenile justice system. Our quantitative descriptive analysis identified a range of themes such as discussions about the poor treatment of families as well as recommendations for a shifting of power to families. These perspectives may provide insights about the context in which families are expected to participate in interventions, meet probationary demands, and provide for their youth's well-being. The results support evidence gathered from families about the impact of youth incarceration on their lives and has implications for practitioners and researchers working with families whose youth have been incarcerated.

Adolescents' Perceptions of a Gardening Activity at a Juvenile Justice Center

PURPOSE

The purpose of this study was to elicit participants' ( N = 16) perceptions of a gardening activity at a juvenile justice center and to determine whether past exposure to gardening and farmers markets was associated with their perceptions of the gardening experience.

DESIGN

This cross-sectional, exploratory program evaluation was conducted in partnership with the Kentucky Department of Juvenile Justice. Adolescents completing the Cadet Leadership and Education Program participated in gardening in order to provide produce to a local farmers' market.

METHOD

After the growing season, participants were asked to complete a nine-item questionnaire about the gardening activity during one of their usual classes at the facility. The questionnaire assessed perception of the experience and past exposure to gardening and farmers' markets.

FINDINGS

Participants reported favorably about their participation in the activity, knowledge gained from the activity, and their intent to garden in the future. Those who had previously gardened had more favorable perception of gardening than those who had never gardened. Gardening is an inexpensive means of teaching teamwork and delayed gratification and providing a sense of empowerment and may benefit at-risk adolescents during incarceration.

Community trauma as a predictor of sexual risk, marijuana use, and psychosocial outcomes among detained African-American female adolescents

Social determinants contribute to health disparities. Previous research has indicated that community trauma is associated with negative health outcomes. This study examined the impact of community trauma on sexual risk, marijuana use and mental health among African-American female adolescents in a juvenile detention center. One hundred and eighty-eight African-American female adolescents, aged 13-17 years, were recruited from a short-term detention facility and completed assessments on community trauma, sexual risk behavior, marijuana use, symptoms of posttraumatic stress disorder and psychosocial HIV/STD risk factors. Findings indicate that community trauma was associated with unprotected sex, having a sex partner with a correctional/juvenile justice history, sexual sensation seeking, marijuana use, affiliation with deviant peers and posttraumatic stress disorder symptoms at baseline and longitudinally. Findings reinforce the impact of community-level factors and co-occurring health issues, particularly in high-risk environments and among vulnerable populations. Structural and community-level interventions and policy-level changes may help improve access to resources and improve adolescents' overall health and standard of living in at-risk communities.