Health risk factors among detained adolescent females

doi:10.1016/j.amepre.2004.07.017

American Journal of Preventive Medicine

Volume 27, Issue 5, December 2004, Pages 404-410

https://doi.org/10.1016/j.amepre.2004.07.017 Get rights and content

Objectives

To identify the prevalence of health risk factors among a sample of detained adolescent females and determine whether there are racial/ethnic differences.

Design and setting

A cross-sectional survey of 197 adolescent females (aged 14 to 18 years) recruited within eight detention facilities.

Outcome measures

Thirty-five measures, comprising four domains, were assessed. Domains were sex-related risk factors, violence-related risk factors, selected mental health issues, and substance abuse behaviors. Measures were collected using audio-computer–assisted self-interviewing. A biological assessment for the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis was also conducted.

Results

Several health risk factors were especially prominent. Mean age of sexual debut was 13 years. The mean number of sex partners (lifetime) was 8.8. Twenty percent tested positive for an STD, and 32.2% had ever been pregnant. Of those reporting sexual activity, 33.9% had not used any form of contraception in the past 2 months and about 40% reported having recent sex with a casual partner. More than 40% reported that a friend had been beaten, attacked, or hurt by others in the past year. More than one half had witnessed violence (past year) and nearly 30% had ever belonged to a gang. Forty percent had thought about committing suicide in the past 2 months, with 35% informing someone of their intent, and 25% attempting suicide. Recent use of illegal substances was common. Correlations between the four domains were significant (p <0.03), but weak. With some notable exceptions (STD prevalence, trading sex for money, witnessing violence), no difference was found between minority and nonminority adolescents with respect to risk factors. After creating an index of all the risk factors, a normal distribution was obtained (mean number of factors, 10.3; standard deviation, 5.0).

Conclusions

Preventive medicine programs for adolescent females within detention facilities are warranted. Our evidence suggests that health risk behaviors in this population may be quite diverse; therefore, these programs should be broad in scope and that depth of the programs should vary as a function of risk level.

Introduction

Contemporary threats to the health of adolescent females are primarily the consequence of risk behaviors and related outcomes such as teenage pregnancy and sexually transmitted diseases (STDs).1, 2 Witnessing violence and residing in neighborhoods characterized by violent behavior also places adolescent females at risk.³ Moreover, selected mental health issues (e.g., suicidality, impulsivity, sexual adventurism) may be common among adolescent females.4, 5

Evidence suggests that adjudicated adolescent females sentenced to detention may be an especially high-risk population, bearing a disproportionate burden of medical and emotional disorders.6, 7, 8, 9, 10 Although providing medical and psychological services during the detention period is clearly important,⁸ the period is also a potentially valuable opportunity to initiate behavioral interventions designed to reduce risk, thereby averting subsequent morbidity.¹⁰ In sharp contrast to studies of detained adolescent males, few studies have specifically investigated health risk among detained females.6, 9, 10, 11, 12

This exploratory study identified health risk factors among a sample of detained adolescent females using behavioral and biological indicators (i.e., STDs). Health risk factors pertaining to pregnancy, sexual risk, violence, selected mental health issues, and substance abuse were identified. In addition, because of evidence suggesting racial disparities in health status among women,¹³ the study examined whether the identified health risk factors differed as a function of nonminority versus minority status. The study also investigated the strength of association between composite measures of risk in four distinct areas: sex-related risk behaviors, violence-related risk factors, selected mental health issues, and substance abuse behavior. Finally, significant correlates of testing positive for at least one of three assessed STDs were identified.

Section snippets

Study sample

Georgia detention facilities house adolescents convicted of offenses ranging from truancy to homicide as well as adolescents who have been temporarily placed in detention before sentencing. Eight detention facilities located in Georgia formed the basis for a cross-sectional survey of adolescents. Research assistants visited each of the eight detention facilities on a weekly basis. At each visit, all newly detained adolescents (i.e., those who had not been detained during the previous visit)

Characteristics of sample

Average age was 15.3 years (standard deviation [SD]=0.96). Nearly 42% identified as white and non-Hispanic, with 36.5% identifying as African American and non-Hispanic, 8.6% as white and Hispanic, 6.1% as African American and Hispanic, and the remainder identifying as other races/ethnicities. Nearly 70% (69.4%) indicated that they had served at least one previous detention sentence. Participants had been in detention for a mean of 36.4 days (SD=67.6), with the median stay of 14.5 days.

Health risk factors

Table 1

Conclusions

This exploratory research provides documentation suggesting that health risk behaviors are found in high proportions among detained adolescent females. This may be true regardless of nonminority versus minority status. Because the detention period is an ideal opportunity to provide health care and health education to this population, preventive medicine programs inside detention walls are clearly warranted. Evidence suggests that these programs should be broad in scope, and that the depth of

References (35)

J.G. Dryfoos
Adolescents at risk
(1990)
E. Ginzberg
Adolescents at Risk Conference: overview
J Adolesc Health
(1991)
G. Margolin et al.
The effects of family and community violence on children
Annu Rev Psychol
(2000)
L. Donohew et al.
Health risk takers and prevention
M.S. Gould
Suicide risk among adolescents
R.E. Morris et al.
Health risk behavioral survey from 39 juvenile correctional facilities in the United States
J Adolesc Health
(1995)
Health status of detained and incarcerated youth
JAMA
(1990)
Health care for incarcerated youth: position paper of the Society for Adolescent Medicine
J Adolesc Health
(2000)
R.A. Feinstein et al.
Medical status of adolescents at time of admission to a juvenile detention center
J Adolesc Health
(1998)
R.A. Crosby et al.
Health issues of juvenile offenders

L.A. Teplin et al.

HIV and AIDS risk behaviors in juvenile detainees: implications for public health policy

Am J Public Health

(2003)

R.J. Canterbury et al.

Prevalence of HIV-related risk behaviors and STDs among incarcerated adolescents

J Adolesc Health

(1995)

D. Satcher

American women and health disparities

J Am Med Womens Assoc

(2001)

C.F. Turner et al.

Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology

Science

(1998)

P. Kissinger et al.

Application of computer-assisted interviews to sexual behavior research

Am J Epidemiol

(1999)

P. Michaud et al.

Alternative methods in the investigation of adolescents' sexual life

J Adolesc Health

(1999)

Carrol KC, Aldeen WE, Morrison M, et al. Evaluation of the Abbott LCx chain reaction assay for detection of Chlamydia...

Cited by (44)

Exploring substance misuse behaviors among black girls in detention: Intersections of trauma, sex, and age
2023, Addictive Behaviors
High risk substance misuse, trauma and gang involvement are prevalent in adolescents and often occur with youth involved with the youth punishment system. Evidence suggests that system involvement is related to trauma histories, substance misuse, as well as gang involvement. This study investigated the associations between individual and peer factors and their relationship to problem drug and alcohol use among Black girls involved with the youth punishment system. Data were collected from 188 Black girls in detention at baseline, as well as 3 and 6 month follow up periods. Measures assessed were abuse history, trauma history, sex while using drugs and alcohol, age, government assistance, and drug use. Significant findings from the multiple regression analyses indicated that younger girls were more likely to have a higher prevalence of having a drug problem than older girls at baseline. Having sex while on drugs and alcohol at the 3 month follow up period was correlated with drug use. These findings highlight how individual and peer factors can influence problem substance misuse, their behavior and peer relationships among Black girls in detention.
Development, acceptability, and perceived effectiveness of a trauma-informed adolescent self-regulation intervention
2023, Evaluation and Program Planning
Youth who have experienced trauma often face challenges with self-regulation and can have diminished health outcomes, including those related to sexual and reproductive health. We developed a 12-session blended e-learning intervention for youth involved in juvenile justice systems to encourage healthy sexual decision-making by improving self-regulation skills. This paper describes the development of the program, e-Practice Self-Regulation, as well as an assessment of program acceptability and perceived effectiveness among youth participants. Data were collected using a feedback survey from youth who both completed (n = 95) and did not complete (n = 80) the intervention. Program acceptability was high among all participants, and over 70 % of both completers and non-completers would recommend e-Practice Self-Regulation to peers. Youth reported positive interactions with facilitators and described sessions as helpful, interesting, and educational. The most common criticism was online session length. A majority in both groups reported perceived effectiveness related to sexual health and self-regulation, which increased with more sessions completed. Results suggest e-Practice Self-Regulation is acceptable to youth participants, who reported learning skills necessary for self-regulation and sexual health and intended to use these skills to avoid unplanned pregnancy.
Predictors of sexual and reproductive health among girls involved in the juvenile legal system: The influence of resources, race, and ethnicity
2022, Children and Youth Services Review
Citation Excerpt :
As a result, SRH risk compounds for system-involved girls of color, who carry the highest burden of outcomes associated with risky sex such as STI/HIV contraction and unintended pregnancy (UIP), despite engaging in fewer sexual risk behaviors compared to system-involved White girls and boys (Barnert et al., 2016; Biswas & Vaughn, 2011; Crosby et al., 2004; Tam et al., 2019; Voisin, Hong, & King, 2012; Logan-Greene et al., 2021). Cross-sectionally, studies find that anywhere between 20 and 50% of detained Black and Latinx girls contract STIs (Crosby et al. 2004; Fasula et al. 2018; Johnston et al. 2015). Further, unintended pregnancy (UIP) rates range from 25 to 29% (Acoca et al. 2004; Gray et al. 2016) among detained girls of color, which is more than twice the rate of UIP among adolescents in the general population (Cavazos-Rehg et al. 2010; Gray et al. 2016).
Girls involved in the juvenile legal system are at among the highest risk for sexual and reproductive health (SRH) challenges. Yet, few studies focus on girls or examine multiple predictors of their SRH in tandem. In addition to individual and familial-level risk factors (e.g., trauma, substance use, parental monitoring), this study also examines the influence of structural disadvantage on girls’ SRH by assessing the degree to which girls’ self-identified resource needs and access challenges across multiple areas (e.g., housing, employment, healthcare) predict SRH risk. Cross-sectional data collected from 269 girls involved in the legal system and their caregivers were analyzed using hierarchical regression analyses. Findings suggest that, over and above individual and familial level predictors, resource access challenges significantly predict girls’ SRH, while high resource needs and access challenges predict Black girls’ SRH specifically. Implications for programming, policy, and research are delineated.
The health of adolescents in detention: a global scoping review
2020, The Lancet Public Health
Citation Excerpt :
Overall, the prevalence of suicidal behaviour was markedly higher among detained adolescents than among adolescents in the general population.51–56 In detained adolescents, the prevalence of suicidal ideation ranged from 12·7% to 59·0% over the lifetime,57–60 2·9–30·6% during the past month,25,28,61–64 2·2–80·0% during the past 6 months,47,65,66 and 15·4–58·1% during the past year67 (appendix p 9);68 and the lifetime prevalence of suicide attempts ranged from 4·0% to 29·4% for males (mean 16·8% [SD 7·1]; median 17·3% [IQR 12·2–20·9])15,40,41,54,59,61,62 and from 20·8% to 51·1% for females (37·3% [10·6]; 39·8% [25·4–43·0]).40,41,59,65 For both sexes combined, the prevalence of suicide attempts was 1·9–6·6% during the past month and 13·3–35·0% during the past year (appendix p 10).11,28,29,41,45,57–64,66,67,69–81
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.
Justice involvement and girls’ sexual health: Directions for policy and practice
2019, Children and Youth Services Review
Arrested girls in the United States (US) are often diverted from detention through referrals to juvenile specialty courts (e.g., juvenile drug court), community-based diversion programs, or pre-adjudicated probation services. Limited research suggests that sexual and reproductive health needs for diverted, or court-involved, non-incarcerated (CINI) girls are similar to that of their detained counterparts. Despite the US justice system's emphasis on diverting youth from detention, research and programmatic efforts to improve sexual and reproductive health outcomes has primarily focused on detained girls. Policy and programming for CINI girls is scant and thus warrants further attention. This report details the immediate sexual and reproductive health needs of CINI girls. We discuss implications of current health care policies and practices for this population and conclude with recommendations for research focused on improving access to sexual and reproductive health care.
Treating Youths in the Juvenile Justice System
2017, Pediatric Clinics of North America
Citation Excerpt :
In comparison, only 48% of high school girls in a population-based survey reported having had sexual experience and only 13% reported having 4 or more lifetime sexual partners.32,33 An earlier study of detained girls reported that the average number of lifetime sex partners was 8.8.34 Rates of STIs (20%–42%) discovered during health evaluations in JJ facilities, are much higher than those in community samples.31,34

View all citing articles on Scopus

View full text

Health risk factors among detained adolescent females

Objectives

Design and setting

Outcome measures

Results

Conclusions

Introduction

Section snippets

Study sample

Characteristics of sample

Health risk factors

Conclusions

Adolescents at risk

Adolescents at Risk Conference: overview

J Adolesc Health

The effects of family and community violence on children

Annu Rev Psychol

Health risk takers and prevention

Suicide risk among adolescents

Health risk behavioral survey from 39 juvenile correctional facilities in the United States

J Adolesc Health

Health status of detained and incarcerated youth

JAMA

Health care for incarcerated youth: position paper of the Society for Adolescent Medicine

J Adolesc Health

Medical status of adolescents at time of admission to a juvenile detention center

J Adolesc Health

Health issues of juvenile offenders

HIV and AIDS risk behaviors in juvenile detainees: implications for public health policy

Am J Public Health

Prevalence of HIV-related risk behaviors and STDs among incarcerated adolescents

J Adolesc Health

American women and health disparities

J Am Med Womens Assoc

Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology

Science

Application of computer-assisted interviews to sexual behavior research

Am J Epidemiol

Alternative methods in the investigation of adolescents' sexual life

J Adolesc Health