Firearm homicide and other causes of death in delinquents: a 16-year prospective study

Interventions to Prevent and Respond to Violence Against Justice-Involved Young Women: A Scoping Review

Young women who have had contact with the criminal justice system (justice-involved young women) have an increased risk of being a victim of violence. However, no reviews have synthesized the evidence on interventions to prevent or respond to violence against justice-involved young women. We conducted a scoping review to identify interventions designed to prevent or respond to violence against justice-involved young women. We searched Medline, Criminal Justice Abstracts, Web of Science, and Google Scholar for peer-reviewed and gray literature published in English from January 1, 2000 until March 23, 2021. Consistent with the public health approach to violence, we included primary, secondary, and tertiary interventions. Excluding duplicates, our search returned 5,603 records, 14 of which met our inclusion criteria. We narratively synthesized the included studies, all of which were conducted in the United States. Most included studies examined a tertiary intervention (n = 10), and few examined a primary (n = 2) or secondary (n = 2) intervention. Across the Joanna Briggs Institute Critical Appraisal Tools, the percentage of items met ranged from 0% to 78%. There was some limited evidence that tertiary interventions that included cognitive behavioral therapy reduced the mental health impacts of violence victimization among justice-involved young women. There was little evidence on primary and secondary interventions. Effective and evidence-based interventions to prevent violence victimization and revictimization against justice-involved young women remains a critical gap in knowledge.

Investing in family-centered early childhood education: A conceptual model for preventing firearm homicide among Black male youth in the United States

INTRODUCTION

Firearms are now the number one killer of children and adolescents in the United States. Firearm homicides among Black male youth are the driver of this increase. Prevention requires a multi-faceted life course approach. Academic achievement has been identified as a protective factor. Early childhood education, which is linked to later achievement, is thus an intervention area of interest. Conceptualizing the potential links between early childhood education and reduced risk for youth firearm homicide is important for guiding policy advocacy and informing future research.

METHODS

This paper presents a conceptual model linking early childhood education to reduced risk for firearm homicide. Each link in the model is discussed, and a corresponding review of the literature is presented. The need for anti-racist policies to strengthen the impact of early childhood education is highlighted.

RESULTS

Early education and firearm homicide research are each well-established but largely disconnected. There are clear immediate benefits of early childhood education; however, these effects wane with time, particularly for youth of color. At the same time, juvenile delinquency-a major risk factor for firearm homicide-is influenced by educational inequities.

CONCLUSIONS

Effective interventions to reduce firearm homicides among Black male youth in the United States are needed. Early childhood education shows promise as an intervention. However, to have an impact, this education needs to be accessible and affordable for all, particularly families of color and low income. Societal structures and policies must also better support the positive gains seen through early childhood education to avoid dissipation.

Violence-Related Death in Young Australians After Contact With the Youth Justice System: A Data Linkage Study

Little is known outside of the United States about the risk of violence-related death among young people who have had contact with the youth justice system (justice-involved young people). We examined violence-related deaths among justice-involved young people in Queensland, Australia. In this study, youth justice records for 48,647 young people (10-18 years at baseline) who were charged, or experienced a community-based order or youth detention in Queensland, Australia (1993-2014) were probabilistically linked with death, coroner, and adult correctional records (1993-2016). We calculated violence-related crude mortality rates (CMRs) and age- and sex-standardized mortality ratios (SMRs). We constructed a cause-specific Cox regression model to identify predictors of violence-related deaths. Of 1,328 deaths in the cohort, 57 (4%) were from violence. The violence-related CMR was 9.5 per 100,000 person-years (95% confidence interval [95% CI] [7.4, 12.4]) and the SMR was 6.8 [5.3, 8.9]. Young Indigenous people had a greater risk of violence-related death than non-Indigenous people (cause-specific hazard ratio [csHR] 2.5; [1.5, 4.4]). Young people who experienced detention had more than twice the risk of violence-related death than those who were charged only (csHR 2.5; [1.2, 5.3]). We found that justice-involved young people have a risk of dying from violence that far exceeds that of the general population. The rate of violence-related death found in this study is lower than that in U.S.-based studies, which most likely reflects lower population level firearm violence in Australia. In Australia, young Indigenous people and those released from detention appear key groups to target for violence prevention efforts.

Nonfatal Firearm Injury and Firearm Mortality in High-risk Youths and Young Adults 25 Years After Detention

Importance

Youths, especially Black and Hispanic males, are disproportionately affected by firearm violence. Yet, no epidemiologic studies have examined the incidence rates of nonfatal firearm injury and firearm mortality in those who may be at greatest risk-youths who have been involved with the juvenile justice system.

Objectives

To examine nonfatal firearm injury and firearm mortality in youths involved with the juvenile justice system and to compare incidence rates of firearm mortality with the general population.

Design, Setting, and Participants

The Northwestern Juvenile Project is a 25-year prospective longitudinal cohort study of 1829 youths after juvenile detention in Chicago, Illinois. Youths were randomly sampled by strata (sex, race and ethnicity, age, and legal status [juvenile or adult court]) at intake from the Cook County Juvenile Temporary Detention Center. Participants were interviewed at baseline (November 1995 to June 1998) and reinterviewed as many as 13 times over 16 years, through February 2015. Official records on mortality were collected through December 2020. Data analysis was conducted from November 2018 to August 2022.

Main Outcomes and Measures

Participants self-reported nonfatal firearm injuries. Firearm deaths were identified from county and state records and collateral reports. Data on firearm deaths in the general population were obtained from the Illinois Department of Public Health. Population counts were obtained from the US census.

Results

The baseline sample of 1829 participants included 1172 (64.1%) males and 657 (35.9%) females; 1005 (54.9%) Black, 524 (28.6%) Hispanic, 296 (16.2%) non-Hispanic White, and 4 (0.2%) from other racial and ethnic groups (mean [SD] age, 14.9 [1.4] years). Sixteen years after detention, more than one-quarter of Black (156 of 575 [27.1%]) and Hispanic (103 of 387 [26.6%]) males had been injured or killed by firearms. Males had 13.6 (95% CI, 8.6-21.6) times the rate of firearm injury or mortality than females. Twenty-five years after the study began, 88 participants (4.8%) had been killed by a firearm. Compared with the Cook County general population, most demographic groups in the sample had significantly higher rates of firearm mortality (eg, rate ratio for males, 2.8; 95% CI, 2.0-3.9; for females: 6.5; 95% CI, 3.0-14.1; for Black males, 2.5; 95% CI, 1.7-3.7; for Hispanic males, 9.6; 95% CI, 6.2-15.0; for non-Hispanic White males, 23.0; 95% CI, 11.7-45.5).

Conclusions and Relevance

This is the first study to examine the incidence of nonfatal firearm injury and firearm mortality in youths who have been involved with the juvenile justice system. Reducing firearm injury and mortality in high-risk youths and young adults requires a multidisciplinary approach involving legal professionals, health care professionals, educators, street outreach workers, and public health researchers.

Not All Survivors Are the Same: Qualitative Assessment of Prior Violence, Risks, Recovery and Perceptions of Firearms and Violence Among Victims of Firearm Injury

Qualitative exploration into the risk, experiences, and outcomes of victims of firearm injury is imperative to informing not only further research, but prevention and intervention strategies. The purpose of this study was to explore prior violent exposures, risks, recovery, supportive services, outcomes, and views of firearms and violence among survivors of firearm assaults and unintentional injuries. Adults treated at a level 1 trauma center in Seattle, WA, for assault and unintentional firearm injuries were interviewed utilizing a semistructured instrument. Interview responses were coded to identify common themes and representative quotes are reported. Sixteen participants were interviewed. Notable themes included the following: (a) prior violent exposures were experienced by half of survivors, mostly through community violence; (b) risk for firearm injury was felt to be related to general societal violence, unsafe communities, and firearm practices; (c) important aspects of recovery included family/social support, mental health care and financial support services; (d) notable outcomes included psychological problems such as PTSD and anxiety, changes in relationships, and developing a new sense of purpose or mission in life; (e) generally negative views toward firearms, supporting restricted access and firearm safety practices; (f) acknowledgement of the complexity of firearm violence in society with prevention geared toward equitable education, economic opportunities and safety net programs to reduce community violence; and (g) disappointment in the criminal justice system. These findings demonstrate the varied experiences, needs, and outcomes after injury, but highlight the significance of community and societal violence, and need for improved mental health services. Integration of mental health services and victim assistance programs into trauma centers and hospital-based violence intervention programs is imperative for all survivors. Encouraging survivors to engage in new aspirations after injury can be empowering, and there is an unmet need for victim support and advocacy within the criminal justice system.

Circumstances and toxicology of violence-related deaths among young people who have had contact with the youth justice system: a data linkage study

Background

Young people who have had contact with the youth justice system have an increased risk of dying from violence. Examining the context of violence-related deaths is essential in informing prevention strategies. We examined the circumstances and toxicology of violence-related deaths among young people who have had contact with the youth justice system in Queensland, Australia.

Methods

This data linkage study linked youth justice records from Queensland, Australia (30 June 1993-1 July 2014) on 48,670 young people to national death and coroner records (1 July 2000-1 January 2017). Circumstances and toxicology of deaths were coded from coroner’s records. We calculated the incidence of violence-related deaths that were reported to a coroner. Fisher’s exact tests were used to examine crude differences in the circumstances and toxicology of violence-related death, according to sex and Indigenous status.

Results

There were 982 deaths reported to a coroner in the cohort. Of which, 36 (4%) were from violence-related causes (incidence: 6 per 100,000 person-years, 95% confidence interval: 4-8). People who died from violence were most frequently male (n = 28/36; 78%), and almost half were Indigenous (n = 16/36; 44%). The majority of violence-related deaths involved a weapon (n = 24/36; 67%), most commonly a knife (n = 17/36; 47%). Compared to men where the violent incident was most frequently preceded by an altercation (n = 12/28; 43%), for women it was frequently preceded by a relationship breakdown or argument (n < 5; p = 0.004). Substances most commonly present in toxicology reports were cannabis (n = 16/23; 70%) and alcohol (n = 15/23; 65%).

Conclusions

Therapeutic alcohol and other drug programs, both in the community and detention, are likely important for reducing violence-related deaths among young people who have had contact with the youth justice system. The majority of violence-related deaths among women were in the context of intimate partner violence, indicating the urgent need for interventions that prevent intimate partner violence in this population. Diversion programs and increased investment in health and social services may reduce the overrepresentation of Indigenous people in the youth justice system and in violence-related deaths.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12244-z.

Mortality and Cause of Death Among Youths Previously Incarcerated in the Juvenile Legal System

Importance

More than 50 000 youths are incarcerated in the United States on any given day, and youth incarceration has been linked to lasting adverse outcomes, including early mortality. Improving our understanding of the factors associated with early mortality among incarcerated youths can inform appropriate prevention strategies.

Objective

To examine mortality rates and causes of death among youths previously incarcerated in the juvenile legal system.

Design, Setting, and Participants

This retrospective longitudinal population-based cohort study compared mortality rates between youths aged 11 to 21 years incarcerated from 2010 to 2017 with same-aged nonincarcerated Medicaid-enrolled youths in the state of Ohio. Data from January 2017 to December 2019 were collected from juvenile incarceration, Medicaid, and death certificate information in Ohio.

Exposure

Incarceration in the state of Ohio's juvenile legal system.

Main Outcomes and Measures

Number, characteristics, and causes of deaths. Poisson regression incidence rate ratios (IRRs) compared mortality rates between previously incarcerated and Medicaid-enrolled youths.

Results

Among 3645 incarcerated youths, 3398 (93.2%) were male, 2155 (59.1%) Black, 1307 (35.9%) White, and 183 (5.0%) other race and ethnicity. Overall, 113 youths (3.1%) died during the study period. Homicide was the leading cause of death in formerly incarcerated youths (homicide: 63 [55.8%]; legal intervention [ie, death due to injuries inflicted by law enforcement]: 3 [2.7%]). All-cause mortality rates were significantly higher among previously incarcerated youths than Medicaid-enrolled youths (adjusted IRR [aIRR], 5.91; 95% CI, 4.90-7.13) in every demographic subgroup. Compared with Medicaid-enrolled youths, mortality rates for previously incarcerated youths were highest for homicide (aIRR, 11.02; 95% CI, 8.54-14.22), overdose (aIRR, 4.32; 95% CI, 2.59-7.20), and suicide (aIRR, 4.30; 95% CI, 2.22-8.33). Formerly incarcerated Black youths had a significantly higher risk of homicide (aIRR, 14.24; 95% CI, 4.45-45.63) but a lower risk of suicide (aIRR, 0.18; 95% CI, 0.04-0.89) and overdose (aIRR, 0.31; 95% CI, 0.10-0.99) than White youths who were incarcerated. Previously incarcerated youths aged 15 to 21 years were significantly more likely to die than youths aged 22 to 29 years, irrespective of cause of death (aIRR for youths aged 22-29 years, 0.09; 95% CI, 0.06-0.14).

Conclusions and Relevance

In this study, youths with a history of incarceration were significantly more likely to experience early mortality compared with nonincarcerated Medicaid-enrolled youths. Delinquency and violence prevention strategies that incorporate a culturally informed approach and consider sex and developmental level are critical.

Violence-related deaths among people released from incarceration: systematic review and meta-analysis of cohort studies

BACKGROUND

People released from incarceration have an increased risk of violence-related death. As deaths from violence are a rare event, meta-analysis is needed to calculate reliable estimates of this risk. We examined the crude mortality rates (CMRs), standardised mortality ratios (SMRs), and predictive factors for violence-related deaths among people released from incarceration.

METHODS

In this systematic review and meta-analysis, we searched MEDLINE, PubMed, PsycINFO, Scopus, Web of Science, CINCH, and Criminal Justice Abstracts from inception to 14 September 2020 for cohort studies published in English that examined violence-related deaths occurring in the community following release from adult or youth incarceration. We used the Methodological Standard for Epidemiological Research (MASTER) scale to assess the quality of included studies. We conducted a random-effects meta-analysis to calculate pooled estimates of the CMRs and SMRs. Heterogeneity was assessed using univariable meta-regression. This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020209422).

FINDINGS

Our search identified 2,489 records, from which 11 studies met the eligibility criteria. The pooled CMR for violence-related deaths after release from incarceration was 78·7 per 100,000 person-years (95%CI 58·0-99·5). The pooled SMR was 7·6 (95%CI 2·4-12·8). The estimate of heterogeneity was high (I²≥99%) and the Cochran's Q test was significant (p<0·001) for the pooled CMR and SMR. Study design (prospective vs. retrospective; p=0·001) and type of incarceration facility (youth detention vs. prison; p=0·006) were identified as possible sources of heterogeneity for CMRs. Risk factors for violence-related death after release were reported in only five studies. These included being male (n=3), Black or Hispanic in the United States (n=3), and younger age at release from incarceration (n=2).

INTERPRETATION

People released from incarceration are almost eight times more likely to die from violence than the general population. Violence-related deaths are preventable, and the high rate at which they occur after release from incarceration represents an important public health issue requiring targeted, evidence-based response.

FUNDING

None.

Rural youth's exposure to firearm violence and their attitudes regarding firearm safety measures

BACKGROUND

In the wake of an epidemic in firearm-related deaths and injuries, youth have become leading voices of concern. This study's objective was to investigate rural youth's personal experiences with firearm-related violence, and their attitudes towards firearms and gun violence prevention strategies.

METHODS

Attendees of the 2019 Iowa FFA Leadership Conference were surveyed about personal experiences with firearm-associated deaths and injuries, and their attitudes regarding firearm-related issues. Descriptive (frequencies), bivariate (chi square, Fisher's exact test) and multivariable logistic regression analyses were performed utilizing Stata 15.1 (StataCorp, College Station, Texas).

RESULTS

Responses from 1382 FFA members 13-18 years of age were analyzed. About 5% had personally seen someone threatened with a firearm. Over one-third (36%) stated they knew someone who had been killed or injured by gunfire. Of these, over two-thirds knew of someone who had died or was injured unintentionally and 30% knew of someone killed or injured intentionally (e.g. suicide). Nearly all agreed or strongly agreed that the right to use firearms for hunting and shooting sports should be legal (94%), that a firearm safety course should be required to get a hunting license (89%), and that there should be a required background check before purchasing a firearm (89%). Over three-fifths (61%) agreed or strongly agreed that there should be laws requiring safe storage of firearms in homes. Although still high, lesser support for firearm safety policies was seen among males, older youth, participants living on farms or in the country, and youth who hunted, had firearms in their homes, and/or were in homes with unsafe firearm storage.

CONCLUSIONS

The majority of youth in this study supported firearm safety measures including required training, background checks, and safe firearm storage in homes. These findings are consistent with the national youth-led call for firearm safety. Additionally, over one-third of respondents personally knew someone who was killed or injured by a firearm and 5% had seen someone or been personally threatened with firearm violence. Our study did not investigate the effects of firearm violence on participants' mental health and wellbeing, but future studies addressing this question seem highly justified.

Association of Firearm Access, Use, and Victimization During Adolescence With Firearm Perpetration During Adulthood in a 16-Year Longitudinal Study of Youth Involved in the Juvenile Justice System

IMPORTANCE

Preventing firearm violence requires understanding its antecedents. Yet no comprehensive longitudinal study has examined how involvement with firearms during adolescence-use, access, and victimization (defined as threatened with a weapon or gunshot injury)-is associated with the perpetration of firearm violence in adulthood.

OBJECTIVE

To examine the association between firearm involvement during adolescence and subsequent firearm perpetration and ownership in adulthood among youth involved in the juvenile justice system.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study analyzed interview responses of 1829 randomly selected participants as part of the Northwestern Juvenile Project, a longitudinal study of health needs and outcomes of youth sampled from a temporary juvenile detention center in a large US city. Youth aged 10 to 18 years were interviewed in detention from November 1995 through June 1998. Participants were reinterviewed up to 13 times over 16 years through February 2015, for a total of 17 776 interviews. The sample was stratified by sex, race/ethnicity, age, and legal status (juvenile or adult court). Data were analyzed from April 2017, when data preparation began, through November 2020.

EXPOSURES

Firearm involvement during adolescence: use (ie, threaten, shoot), access (ownership, ease of access, firearm in household, membership in gang that carries firearms), and victimization (gunshot injury, threatened with a weapon).

MAIN OUTCOMES AND MEASURES

Firearm involvement during adulthood: perpetration of firearm violence (ie, threatening with or using a firearm) and firearm ownership.

RESULTS

Among the 1829 participants, 1388 had a 16-year follow-up interview: 860 males, 528 females; 809 were African American, 203 were non-Hispanic White; 374 were Hispanic; and 2 were other race/ethnicity; median (interquartile range) age of 32 (30-32) years. Eighty-five percent of males and 63.2% of females were involved with firearms as adolescents. Compared with females, males had significantly higher odds of every type of involvement except having a firearm in the home. In adulthood, 41.3% of males and 10.5% of females perpetrated firearm violence. Adolescents who had been threatened with a weapon or injured by firearms had 3.1 (95% CI, 2.0-4.9) and 2.4 (95% CI, 1.2-4.9) times the odds of perpetrating violence during adulthood. Similar associations were found for firearm ownership.

CONCLUSIONS AND RELEVANCE

Involvement with firearms during adolescence-including victimization-is a significant risk factor for firearm perpetration and ownership during adulthood.

Violence-related deaths among people released from incarceration: protocol for a systematic review

INTRODUCTION

Young people and adults released from incarceration have a risk of dying from violence that far exceeds that in the general population. Despite this, evidence regarding the incidence, elevated risk and predictive factors for violence-related deaths after release have not yet been synthesised. This information is important to inform the development of evidence-based approaches to effectively prevent deaths from violence in this population. This systematic review will synthesise the literature examining the crude mortality rates (CMRs), standardised mortality ratios (SMRs) and predictive factors for violence-related deaths among people released from incarceration.

METHODS AND ANALYSIS

We searched key electronic health, social science and criminology databases (MEDLINE, PubMed, PsycINFO, Scopus, Web of Science, CINCH, Criminal Justice Abstracts) for peer-reviewed cohort studies published in English on 14^th September 2020. Our primary outcome of interest is violence-related deaths occurring in the community following release from incarceration. We will not restrict study eligibility by year of publication or age of participants. The Methodological Standard for Epidemiological Research (MASTER) scale will be used to assess the quality of included studies. If there are sufficient studies and homogeneity between studies, we will conduct meta-analyses to calculate pooled estimates of CMRs, SMRs or predictive factors for violence-related deaths. If there is a sufficient number of included studies, meta-regression will be conducted to examine the influence of subgroups and methodological factors on the CMRs, SMRs or predictive factors. If the studies do not report sufficient data, or if there is substantial heterogeneity, findings will be presented in a narrative form.

ETHICS AND DISSEMINATION

This review is exempt from ethics approval as it will synthesise findings from published studies that have already obtained ethics approval. Our findings will be disseminated through a peer-reviewed journal article, and national and international conference and seminar presentations.

TRIAL REGISTRATION DETAILS

This study is registered with PROSPERO (CRD42020209422).

Epidemiological profile of female firearm-related mortality

ABSTRACT

The mortality rate of women due to firearms increases every day in Brazil and globally. This study aimed to evaluate the trends of firearm-related mortality in women from the years 2007 to 2016 in order to determine their profile and to associate these indicators with public policy and strategies to reduce mortality.This is an ecological time-series study using secondary data of women aged 10 to 49 years old collected through the mortality information system (SIM) in Brazil. Furthermore, independent characteristics such as education, color, race and civil status were also collected from SIM. Data was analyzed using the Join Point open source software version.There was an increase in the mortality rate of women who received 4 to the 7 years of education, were single, and brown-skinned. There was a significantly increased rate of mortality in women whose ages ranged from 20 to 29 years followed by 30 to 39 years; the rate was also significantly higher in the northeast region followed by the southeast region.There is a need for professional training to assist women in vulnerable situations.

Retinopathy of Prematurity

Retinopathy of prematurity (ROP), formerly called retro-lental fibroplasia (RLF), has increased in the 1980s due to a high incidence of premature, low birthweight infants. Apparently, oxygen administration alone does not account for all these ROP babies. Birth-weight, gestational age, and duration of administration of oxygen are primary contributors to ROP development. The stages of severity range from no visual damage to total blindness. Treatments are either pharmacological or surgical. Vitamin E therapy, photocoagulation procedures, cryotherapy, scleral buckling procedures, and vitrectomy are common treatments, but none is totally successful in ameliorating this condition. The educational problems of children with ROP parallel those of other visually impaired children, with deficits found primarily in exploration, mobility, and language. Referral to early intervention programs can provide a comprehensive structured learning situation and support to the entire family.

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.

The health of adolescents in detention: a global scoping review

Adolescents detained within the criminal justice system are affected by complex health problems, health-risk behaviours, and high rates of premature death. We did a global synthesis of the evidence regarding the health of this population. We searched Embase, PsycINFO, Education Resources Information Center, PubMed, Web of Science, CINCH, Global Health, the Cochrane Database of Systematic Reviews, the Campbell Library, the National Criminal Justice Reference System Abstract Database, and Google Scholar for peer-reviewed journal articles, including reviews, that reported the prevalence of at least one health outcome (physical, mental, sexual, infectious, and neurocognitive) in adolescents (aged <20 years) in detention, and were published between Jan 1, 1980, and June 30, 2018. The reference lists of published review articles were scrutinised for additional relevant publications. Two reviewers independently screened titles and abstracts, and three reviewed full texts of relevant articles. The protocol for this Review was registered with PROSPERO (CRD42016041392). 245 articles (204 primary research articles and 41 reviews) were included, with most primary research (183 [90%]) done in high-income countries. A high lifetime prevalence of health problems, risks, and conditions was reported in detained adolescents, including mental disorders (0–95%), substance use disorders (22–96%), self-harm (12–65%), neurodevelopmental disabilities (2–47%), infectious diseases (0–34%), and sexual and reproductive conditions (pregnant by age 19 years 20–37%; abnormal cervical screening test result 16%). Various physical and mental health problems and health-risk behaviours are more common among adolescents in detention than among their peers who have not been detained. As the social and structural drivers of poor health overlap somewhat with factors associated with exposure to the criminal justice system, strategies to address these factors could help to reduce both rates of adolescent detention and adolescent health inequalities. Improving the detection of mental and physical disorders, providing appropriate interventions during detention, and optimising transitional health care after release from detention could improve the health outcomes of these vulnerable young people.

Race/Ethnicity, and Behavioral Health Status: First Arrest and Outcomes in a Large Sample of Juvenile Offenders

The objective of this study was to assess the simultaneous effects of gender, race/ethnicity, and pre-arrest behavioral health (BH) service-use on age at first arrest, and first arrest outcomes. Between January 2004 and December 2011, arrest and medical records were collected on a retrospective longitudinal cohort of 12,476 first-time offenders, ages 8-18 years. Black youth were arrested at younger ages than white or Hispanic youth. Youth with psychiatric problems were arrested at younger ages than youth with substance-use, dual-diagnoses, or no BH problems. Compared to white males, black males had lower odds of detention and BH referrals. Compared to white females, black females had higher odds of release and lower odds of probation, detention, and BH referrals. A significant gender-by-BH problem interaction revealed males and females with previous psychiatric problems were arrested at younger ages than youth with substance, dual-diagnosis, or no prior problems. Implications are discussed.

Social workers' determination of when children's access or potential access to loaded firearms constitutes child neglect

Background

Pediatric firearm-related deaths and injuries are a serious societal problem. Our study’s objective was to determine social workers’ assessment of child neglect with respect to access or potential access to a loaded firearm.

Methods

Study invitations were delivered by e-mail to National Association of Social Workers members designating their practice as “Child/Family Welfare” (N = 4933) in October/November, 2015. Demographics, attitudes regarding child access prevention (CAP) laws, and the ages (4–14 years) at which social workers deemed several scenarios as child neglect were determined. Descriptive (frequencies) and bivariate (chi square) analyses were performed.

Results

485 of 4933 social workers completed the survey (9.8%). Of these, most agreed or strongly agreed (≥92%) there should be laws in place requiring firearms to be stored so unwanted access cannot be obtained by a child, even up to 15 years of age. In a scenario where a child had potential access to a loaded firearm, but never gained access, the presence of a CAP law pertinent to the child in the scenario increased the likelihood respondents would find the situation child neglect for all ages (p < 0.0001 for each age comparison). Moreover, 10.3% felt they could not deem the situation child neglect without the presence of a CAP law, no matter the age of the child. In a scenario where a child gained access to a loaded firearm, the vast majority found this to be child neglect (82–99%, with the percentage varying by the age of the child involved), regardless of the presence or absence of a CAP law and/or an injury being sustained. In addition, when a CAP law was in place, social workers were more likely to find neglect if the child had sustained a firearm-related injury as well (p values ranged from 0.016–0.0081 for age comparisons).

Conclusions

The vast majority of child/family welfare social workers surveyed found it to be child neglect when youth accessed or had potential access to a loaded, unsecured firearm. Results of the study provide support for the passage of universal CAP laws to help protect children equally across states and ensure the safe storage of firearms in homes.

Understanding and Improving the Health of People Who Experience Incarceration: An Overview and Synthesis

The world prison population is growing at a rate that exceeds the rate of population growth. This issue of Epidemiologic Reviews comprises articles in which researchers summarize what is known about some of the key health issues facing people in prison, particularly in relation to human immunodeficiency virus and other blood-borne viral infections. A key recurring theme is that addressing the health needs of people in prison is important to reducing health inequalities at the population level—that prisoner health is public health. The reviews also highlight some critical evidence gaps, notably the lack of evidence from low- and middle-income countries, and the limited number of longitudinal studies in which health behaviors, health outcomes, or health service experiences after release from prison are documented. Despite growing evidence of the poor health of detained adolescents, none of the included reviews considered this population. Further research on the health of young people who cycle through juvenile detention should be a priority. Despite a rapidly growing literature on the health of people who experience incarceration, some critical health issues remain poorly understood, and there has been insufficient attention devoted to co-occurring health conditions and the consequent need for coordinated care. Key populations in custodial settings remain understudied, limiting capacity to develop targeted, evidence-based responses to their health needs. The quality of many studies is suboptimal, and although rigorous, independent research in correctional settings can be challenging, it is not impossible and is critical to laying the groundwork for evidence-based reform.

Independent predictors of mortality in adolescents ascertained for conduct disorder and substance use problems, their siblings and community controls

BACKGROUND AND AIMS

Adolescents with conduct and substance use problems are at increased risk for premature mortality, but the extent to which these risk factors reflect family- or individual-level differences and account for shared or unique variance is unknown. This study examined common and independent contributions to mortality hazard in adolescents ascertained for conduct disorder (CD) and substance use disorder (SUD), their siblings and community controls, hypothesizing that individual differences in CD and SUD severity would explain unique variation in mortality risk beyond that due to clinical/control status and demographic factors.

DESIGN

Mortality analysis in a prospective study (Genetics of Antisocial Drug Dependence Study) that began in 1993.

SETTING

Multi-site sample recruited in San Diego, California and Denver, Colorado, USA.

PARTICIPANTS

A total of 1463 clinical probands were recruited through the juvenile correctional system, court-mandated substance abuse treatment programs and correctional schools, along with 1399 of their siblings, and 904 controls.

MEASUREMENTS

Mortality and cause-of-death were assessed via National Death Index search (released October, 2017).

FINDINGS

There were 104 deaths documented among 3766 (1168 female) adolescents and young adults (average age 16.79 years at assessment, 32.69 years at death/censoring). Mortality hazard for clinical probands and their siblings was 4.99 times greater than that of controls (95% confidence interval = 2.40-10.40; P < 0.001). After accounting for demographic characteristics, site, clinical status, familial dependence and shared contributions of CD and SUD, CD independently predicted mortality hazard, whereas SUD severity did not.

CONCLUSIONS

In the United States, youth with conduct and substance use disorders and their siblings face far greater risk of premature death than demographically similar community controls. In contrast to substance use disorder severity, conduct disorder is a robust predictor of unique variance in all-cause mortality hazard beyond other risk factors.

Incidence and risk factors for mortality after release from prison in Australia: a prospective cohort study

AIMS

To estimate the incidence and identify risk factors for mortality in adults released from prisons in the state of Queensland, Australia.

DESIGN

Prospective cohort study, linking baseline survey data with a national death register.

SETTING

Selected prisons within Queensland, Australia.

PARTICIPANTS

Adults (n = 1320) recruited in Queensland prisons within 6 weeks of expected release, between August 2008 and July 2010, followed for up to 4.7 years in the community.

MEASUREMENTS

Participants completed a comprehensive baseline survey covering psychosocial circumstances, physical and mental health, substance use and health risk behaviours. Clinical data were abstracted from prison medical records and obtained through probabilistic linkage with state-based, community health records. Dates of prison release and reincarceration were obtained from correctional records. Deaths were identified through probabilistic linkage with the National Death Index. Adjusted hazard ratios (AHR) were calculated using proportional hazards regression models. Standardized mortality ratios (SMR) were calculated using the population of Queensland as the reference. General population data were obtained from the Australian Bureau of Statistics.

FINDINGS

The rate of mortality in the cohort was higher than in the age- and sex-matched general population of Queensland for all causes [SMR = 4.0, 95% confidence interval (CI) = 2.9-5.4] and drug-related causes (SMR = 32, 95% CI = 19-55). In a multivariable model, adjusting for age, sex and Indigenous status, factors associated with increased mortality risk included expecting to have average or better funds available on release (AHR = 2.9, 99% CI = 1.2-7.1), poor mental health (AHR = 2.6, 99% CI = 1.1-6.1) and self-reported life-time history of overdose (AHR = 2.5, 99% CI = 1.04-6.2).

CONCLUSIONS

People released from prison in Queensland, Australia are at increased risk of death, due particularly to drug-related causes. Those at greatest risk of death are characterized by poor physical and mental health and a history of risky substance use.

Self-Harm among Young People Detained in the Youth Justice System in Sri Lanka

Self-harm is prevalent in incarcerated adults, yet comparatively few studies of self-harm in detained youth (and even fewer in low- and middle-income countries) have been published. We examined the prevalence and correlates of self-harm in a sample of 181 young people (mean age 15.0 years, SD = 2.3) detained in the youth justice system in Sri Lanka. Structured face-to-face questionnaires assessed demographic characteristics, family and social background, substance use, self-harm history (including frequency, method, and intention), bullying victimization, physical and sexual abuse (victimization and perpetration), and exposure to self-harm/suicide by others. Seventy-seven participants (43%) reported a lifetime history of self-harm, 19 of whom (25%) who reported doing so with suicidal intent. Fifty participants (65% of those with a history of self-harm) reported engaging in self-harm impulsively, with no prior planning. A history of self-harm was associated with being female, prior sexual abuse victimization, prior exposure to self-harm by friends, and a lifetime history of self-harm ideation. High rates of substance use, bullying victimization, parental incarceration, and exposure to suicide were reported across the sample. Young people detained in the youth justice system in Sri Lanka are a vulnerable group with high rates of self-harm, substance use, and psychosocial risk factors. Strategies for identifying and preventing self-harm, and targeted psychological interventions designed specifically to address impulsivity, may contribute to more positive outcomes in this marginalised population.

Child welfare professionals' determination of when children's access or potential access to loaded firearms constitutes child neglect

BACKGROUND

Pediatric deaths and injuries from access to firearms are a significant public health problem. No studies have examined how experts determine child neglect regarding firearm access in the home. Our study objectives were to identify factors that influenced pediatric experts' finding of firearm-related child neglect and to assess their attitudes toward child access prevention (CAP) laws.

METHODS

A survey was distributed to the American Academy of Pediatrics Section on Child Abuse and Neglect members. Demographics, attitudes regarding CAP laws, and ages (up to 14 years old) at which experts deemed several scenarios as child neglect were determined. Scenarios tested potential versus actual loaded firearm access, presence or absence of a CAP law, and injury versus no injury when the firearm was accessed.

RESULTS

One hundred ninety-three surveys were completed. Experts agreed (>95%) that CAP laws were important, even for children up to age 15 years. Although a high percentage considered potential access to a loaded firearm as child neglect, a CAP law significantly increased the percentage for each age. In addition, higher percentages of respondents from states with CAP laws than those without deemed potential access as child neglect for 12- and 14-year-olds. In contrast, if the child had accessed a loaded firearm, there were no significant differences in the high percentages that deemed the scenario as child neglect under any conditions, including with and without a CAP law.

CONCLUSIONS

Although almost all child neglect experts considered potential and actual access to loaded firearms as child neglect, CAP laws increased the percentage for cases of potential access. Universal CAP laws may help ensure that determinations of child neglect are more consistent across states. The deterrent effect of potential child neglect findings may increase the number of parents securing firearms in ways that prevent child access and reduce firearm-related deaths and injuries.

LEVEL OF EVIDENCE

Epidemiologic study, level III.

Evaluating the Hispanic Paradox in the Context of Adolescent Risky Sexual Behavior: The Role of Parent Monitoring

OBJECTIVE

In the United States, Hispanic adolescents are at elevated risk for negative outcomes related to risky sexual behavior. To evaluate potential protective factors for this group, we examined the fit of the Hispanic Paradox for sexual behavior among high-risk youth and the moderating role of parent monitoring.

METHOD

We enrolled 323 justice-involved Hispanic youth (73% male; mean age 16 years), and measured generational status, parent monitoring (monitoring location, who children spend time with outside of school, family dinner frequency), and sexual risk behavior.

RESULTS

There were no main effects for generational status on sexual behavior. Parent monitoring of location moderated the relationship between generational status and sexual behavior, such that greater monitoring of location was associated with less risky sexual behavior, but only for youth second generation and above.

CONCLUSIONS

Rather than direct evidence supporting the Hispanic Paradox, we found a more nuanced relationship for generational status in this sample.

A Behavioral Measure of Costly Helping: Replicating and Extending the Association with Callous Unemotional Traits in Male Adolescents

BACKGROUND

Some conduct-disordered youths have high levels of callous unemotional traits and meet the DSM-5's "with limited prosocial emotions" (LPE) specifier. These youths often do aggressive, self-benefitting acts that cost others. We previously developed a task, the AlAn's game, which asks participants to repeatedly decide whether to accept or reject offers in which they will receive money but a planned charity donation will be reduced. In our prior work, more "costly helping" (i.e., rejecting the offered money and protecting the donation) was associated with lower callous unemotional traits. Here we extend that prior work in a larger sample of adolescent male patients with serious conduct problems and controls, and test whether this association is mediated specifically by a Moral Elevation response (i.e., a positive emotional response to another's act of virtue).

METHODS

The adolescent male participants were: 45 patients (23 with LPE) and 26 controls, who underwent an extensive phenotypic assessment including a measure of Moral Elevation. About 1 week later participants played the AlAn's game.

RESULTS

All AlAn's game outcomes demonstrated significant group effects: (1) money taken for self (p = 0.02); (2) money left in the charitable donation (p = 0.03); and, (3) costly helping (p = 0.047). Controls took the least money and did the most costly helping, while patients with LPE took the most money and did the least costly helping. Groups also significantly differed in post-stimulus Moral Elevation scores (p = 0.005). Exploratory analyses supported that the relationship between callous unemotional traits and costly helping on the AlAn's game may be mediated in part by differences in Moral Elevation.

CONCLUSIONS

The AlAn's game provides a standardized behavioral measure associated with callous unemotional traits. Adolescents with high levels of callous unemotional traits engage in fewer costly helping behaviors, and those differences may be related to blunting of positive emotional responses.

Mortality of Youth Offenders Along a Continuum of Justice System Involvement

INTRODUCTION

Black male youth are at high risk of homicide and criminal justice involvement. This study aimed to determine how early mortality among youth offenders varies based on race; gender; and the continuum of justice system involvement: arrest, detention, incarceration, and transfer to adult courts.

METHODS

Criminal and death records of 49,479 youth offenders (ages 10-18 years at first arrest) in Marion County, Indiana, from January 1, 1999, to December 31, 2011, were examined. Statistical analyses were completed in November 2014.

RESULTS

From 1999 to 2011 (aggregate exposure, 386,709 person-years), 518 youth offender deaths occurred. The most common cause of death was homicide (48.2%). The mortality rate of youth offenders was nearly 1.5 times greater than that among community youth (standardized mortality ratio, 1.48). The youth offender mortality rate varied depending on the severity of justice system involvement. Arrested youth had the lowest rate of mortality (90/100,000), followed by detained youth (165/100,000); incarcerated youth (216/100,000); and youth transferred to adult court (313/100,000). A proportional hazards model demonstrated that older age, male gender, and more severe justice system involvement 5 years post-arrest predicted shorter time to mortality.

CONCLUSIONS

Youth offenders face greater risk for early death than community youth. Among these, black male youth face higher risk of early mortality than their white male counterparts. However, regardless of race/ethnicity, mortality rates for youth offenders increase as youth involvement in the justice system becomes more protracted and severe. Thus, justice system involvement is a significant factor to target for intervention.

Long-term mortality of patients surviving firearm violence

OBJECTIVE

We aim to calculate the 5-year mortality after surviving to hospital discharge after a firearm injury and estimate the association of firearm injury with later mortality.

METHODS

We performed a retrospective cohort study of patients from an urban emergency department (ED) and trauma centre in Oakland, California, USA, in 2007. We created three cohorts of patients presenting for (1) gunshot wound (GSW), (2) MVC and (3) assault without a firearm. Demographic and clinical information was obtained from the clinical chart, and the California Department of Public Health Vital Statistics and Social Security Death Master File (2007-2012) were queried to identify patients who died.

RESULTS

We analysed 516 GSW patients, 992 MVC patients and 695 non-GSW assault patients. Of the GSW patients, 86.4% were alive at 5 years. All-cause 5-year mortality among GSW victims surviving to discharge after injury was 5.1%. Compared with MVC patients, both GSW and non-GSW assault patients have higher risk of death at 5 years (HR 2.54 (95% CI 1.41 to 4.59) and HR 1.64 (95% CI 1.01 to 2.68), respectively), adjusting for age, sex and race. Risk of death was higher in the first year for the GSW cohort (HR 6.14 (95% CI 2.35 to 16.08) and HR 5.06 (95% CI 1.88 to 13.63) as compared with MVC and non-GSW assault cohorts, respectively). Homicide was the cause of death in 79.2% of GSW patients who died after surviving the index injury.

CONCLUSION

Among individuals presenting to the ED after injury or assault and surviving to discharge, firearm injury exposure is an important predictor of death within 5 years and most pronounced in the first year after injury.

Risks, Outcomes, and Evidence-Based Interventions for Girls in the US Juvenile Justice System

The proportion of the juvenile justice population that comprises females is increasing, yet few evidence-based models have been evaluated and implemented with girls in the juvenile justice system. Although much is known about the risk and protective factors for girls who participate in serious delinquency, significant gaps in the research base hamper the development and implementation of theoretically based intervention approaches. In this review, we first summarize the extant empirical work about the predictors and sequelae of juvenile justice involvement for girls. Identified risk and protective factors that correspond to girls' involvement in the juvenile justice system have been shown to largely parallel those of boys, although exposure rates and magnitudes of association sometimes differ by sex. Second, we summarize findings from empirically validated, evidence-based interventions for juvenile justice-involved youths that have been tested with girls. The interventions include Functional Family Therapy, Multisystemic Therapy, Multidimensional Family Therapy, and Treatment Foster Care Oregon (formerly known as Multidimensional Treatment Foster Care). We conclude that existing evidence-based practices appear to be effective for girls. However, few studies have been sufficiently designed to permit conclusions about whether sex-specific interventions would yield any better outcomes for girls than would interventions that already exist for both sexes and that have a strong base of evidence to support them. Third, we propose recommendations for feasible, cost-efficient next steps to advance the research and intervention agendas for this under-researched and underserved population of highly vulnerable youths.