June 2005

Grant Results

SUMMARY

Between 1995 and 1998, researchers from Northwestern University Medical School interviewed 1,829 youth detained at the juvenile facility in Cook County, Ill., as part of a longitudinal study of the health issues and outcomes of youth in juvenile detention.

The investigators conducted follow-up interviews from 2001 to 2003 in order to assess longer-term outcomes related to:

  • Substance abuse
  • Psychiatric disorders
  • HIV/AIDS risk behaviors.

Key Findings
The investigators reported these key findings from the initial interviews completed between 1995 and 1998:

  • Half of the males and 46.8 percent of females had a substance use disorder.
  • Nearly two-thirds of males and nearly three-quarters of females met diagnostic criteria for one or more psychiatric disorders.
  • Nearly 14 percent of females and 11 percent of males had both a major psychiatric disorder and a substance use disorder.
  • Drug risk behaviors were common among both males and females, particularly among non-Hispanic white and Hispanic youth.
  • More males than females engaged in sexual risk behaviors, with a higher prevalence of such behavior among African-American males than among non-Hispanic white males.

Funding
The Robert Wood Johnson Foundation (RWJF) provided $749,905 from 2001 to 2003 to support the second phase of this study and the analysis and reporting of the 1998 baseline data.

Eleven federal agencies, led by the National Institute of Mental Health and the William T. Grant Foundation, provided major funding of $10,997,008 in total for the project. Three other foundations provided additional funding (see Appendix 1).

 See Grant Detail & Contact Information
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THE PROBLEM

As of the posting of this report, over 104,000 youth under age 18 are in custody in juvenile facilities in the United States, according to the Office of Juvenile Justice and Delinquency Prevention at the U.S. Department of Justice.

Public health professionals speculate that many of these youth have or will develop substance abuse/dependence and comorbid psychiatric disorders (i.e., more than one disorder occurring at the same time); that these youth are disproportionately the victims and perpetrators of violence; and that these youth engage in the most serious HIV/AIDS risk behaviors.

There have been few studies of the health issues affecting delinquent youth, including their needs for health care services; how well the juvenile justice, educational and health service systems serve these youth; and their outcomes over time.

The Northwestern Juvenile Project at Northwestern University Medical School is the first large-scale longitudinal study of alcohol, drug and psychiatric disorders; service use; and outcomes in delinquent youth.

With funding from the National Institute of Mental Health, researchers from the Northwestern Juvenile Project conducted baseline interviews of 1,829 African American, Hispanic and non-Hispanic White youth (1,172 males and 657 females, ages 10 to 18) who were originally arrested and detained between 1995 and 1998 in the Cook County, Ill., Temporary Detention Center. A consortium of federal agencies and private foundations provides support for ongoing data collection and analysis. See Appendix 1 for a list of funders.

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RWJF STRATEGY

RWJF funded the second phase of this longitudinal study to ensure that data collection included questions about substance abuse treatment needs and services. The project supported RWJF's objective to reduce the harm caused by substance abuse and to understand the service profiles of very high risk/high needs youth. RWJF currently funds the national program Reclaiming Futures®: Communities Helping Teens Overcome Drugs, Alcohol and Crime. It focuses on:

  • Developing new service delivery models that integrate comprehensive services into the juvenile justice system and promoting the creation of community-based systems of care for substance-abusing youthful offenders.
  • Fostering the development of local judicial leadership to guide juvenile justice and substance abuse treatment partnerships, and assist community-based treatment providers in assessing their effectiveness.

RWJF also funds a related study that follows youthful offenders over time, entitled Longitudinal Study of Substance Abuse and Anti-Social Behavior Among Serious Adolescent Offenders (Grant ID# 043357). See Appendix 2 for a list of prior related grants.

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THE PROJECT

Continuing research that began with the 1995 to 1998 baseline data collection, Northwestern Juvenile Project researchers re-interviewed the same youth at three and at four and one-half years after each youth's baseline interview. The follow-up study used the same survey instruments and included a urine drug test to supplement the participants' self-report about substance use.

Researchers also re-interviewed a subsample of 1,000 youth at three and one-half and four years after baseline in order to track experience every six months. Further, interviewers gathered specific HIV and AIDS risk data from a random sample of 800 (460 males and 340 females) study participants. The ongoing investigation focuses on three health issues of delinquent youth:

  1. substance use, abuse and dependence
  2. comorbidity of substance use with psychiatric disorders
  3. HIV/AIDS risk behaviors.

During the grant period, the researchers also continued analysis and reporting of findings from the baseline interviews. See Appendix 3 for additional information on methodology.

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FINDINGS

The investigators have not released findings from the latest interviews which included the questions about substance abuse treatment needs and services that RWJF added to the Northwestern Juvenile Project survey, but have reported a series of key findings from the baseline interviews (data collection not funded by RWJF). These baseline findings related to substance use, abuse and dependence were reported in an issue of the OJJDP (Office of Juvenile Justice and Delinquency Prevention) Bulletin entitled Detection and Prevalence of Substance Use Among Juvenile Detainees.

  • A majority of the youth interviewed reported using some substance in the last six months (77.3 percent) and at some point in their lives (90.1 percent). Similar percentages (77.1 percent and 90.1 percent, respectively) reported use of marijuana, indicating that almost all youth who report any substance use report marijuana use. Self-reported use of other substances was much less common: 8.0 percent in the last six months and 13.0 percent at any point.
  • Urine tests revealed patterns similar to the self-reports. Two-thirds (66.4 percent) of interviewed youth tested positive for any drug, 65.9 percent for marijuana. Among youth testing positive, 87.7 percent reported use of any substance in the last six months and 94.1 percent reported lifetime use.
  • The combination of self-report and urinalysis results shows that at least 85.4 percent of detained youth had used some kind of illicit substance in the past six months and at least 94 percent had done so at some point in their lifetime. Minimum prevalence for substances other than marijuana was much lower: 12.2 percent in the past six months and 16.6 percent during lifetime.
  • Ten percent of youth who reported using drugs said they first used the drugs at or before age 11 and 25 percent said their first use was at or before age 12. Among youth reporting cocaine use, 10 percent said they first used it before age 11 and 50 percent reported first use before age 15.

Researchers reported baseline findings related to psychiatric disorders and comorbidity of substance use with psychiatric disorders in detained youth in three articles in Archives of General Psychiatry: "Psychiatric Disorders in Youth in Juvenile Detention", "Comorbid Psychiatric Disorders in Youth in Juvenile Detention" and "Posttraumatic Stress Disorder and Trauma in Youth in Juvenile Detention."

  • Nearly two-thirds (66.3 percent) of males and nearly three-quarters (73.8 percent) of females met diagnostic criteria for one or more psychiatric disorders. Excluding conduct disorder (common among detained youth), 59.7 percent of males and 68.2 percent of females met diagnostic criteria and had a functional impairment related to the diagnosis for at least one psychiatric disorder.
  • Half (50.7 percent) of males and 46.8 percent of females had a substance use disorder, such as alcohol or marijuana use.
  • More than 40 percent of the youth (41.4 percent of males and 45.6 percent of females) met criteria for a disruptive behavior disorder (oppositional-defiant disorder, conduct disorder).
  • Females had higher rates of affective disorders, such as a major depressive episode or a manic episode (27.6 percent versus 18.7 percent of males). Females, non-Hispanic Whites and older adolescents demonstrated higher levels of many disorders, than males, African Americans and Hispanics, and younger adolescents, respectively.
  • More females (56.5 percent) than males (45.9 percent) met criteria for two or more psychiatric disorders, including major depressive, manic, psychotic, attention-deficit/hyperactivity, alcohol use disorder, and others. Some 17.3 percent of females and 20.4 percent of males had only one disorder.
  • Nearly 14 percent of females and 11 percent of males had both a major psychiatric disorder (psychosis, manic episode or major depressive disorder) and a substance use disorder. Compared with youth having no major psychiatric disorder, those with a major psychiatric disorder had significantly greater odds (1.8 to 4.1) of having substance use disorders. Nearly 30 percent of females and more than 20 percent of males with substance use disorders had major psychiatric disorders. Rates of some types of co-morbidity were higher among non-Hispanic Whites and older adolescents.
  • Most (92.5 percent) of the subsample interviewed on post-traumatic stress had experienced one or more traumas, with more males (93.2 percent) than females (84.0 percent) reporting a traumatic experience. Some 11.2 percent met criteria for posttraumatic stress disorder, with more than half of these youth reporting witnessing violence as the trauma experienced.

Researchers reported baseline findings related to HIV/AIDS risk behaviors of those in detention in an article published in the American Journal of Public Health, entitled "HIV and AIDS Risk Behaviors in Juvenile Detainees: Implications for Public Health Policy."

  • Significantly more males than females engaged in sexual risk behaviors. Of the males, 91.0 percent were sexually active and 60.8 percent had more than one partner in the last three months. While 86.7 percent of females were sexually active, 26.3 percent had more than one partner in the last three months.
  • Drug risk behaviors were common among both males and females. Some 87.8 percent of males and 90.6 percent of females had used alcohol while 93.9 percent of males and 90.7 of females had used marijuana at some point in their lifetimes. While 42.7 percent of males and 45.4 percent of females had been tattooed, needle sharing for injection drug use or tattooing was rare in both sexes.
  • Among males, significantly more African Americans than non-Hispanic Whites engaged in sexual risk behaviors. For example, 64.7 percent of African-American males had more than one partner in the last six months, versus 32.7 percent of non-Hispanic Whites.
  • Many drug risk behaviors were more prevalent among non-Hispanic White males and Hispanic males than among African Americans. For example, 57.9 percent of non-Hispanic White males and 49.8 percent of Hispanic males had ever used drugs other than marijuana, in comparison to 3.9 percent of African-American males. The reason for this finding is that only very dysfunctional White and Hispanic males end up in detention and they are therefore far more likely to be engaging in drug risk behaviors than the African-American males in detention. African-American males are much more likely to end up in detention because of racial biases in detaining them.
  • Among females, significantly more non-Hispanic Whites engaged in sexual risk behaviors. For example, 61.8 percent of non-Hispanic White females had recent unprotected vaginal sex compared to 35.5 percent of African-American and 42.5 percent of Hispanic females.
  • Drug risk behaviors were more prevalent among non-Hispanic White and Hispanic females than among African Americans. For example, 58.4 percent of non-Hispanic White females and 55.0 percent of Hispanic females had ever used substances other than marijuana, versus 4 percent of African-American females. The reason for this finding is the same as for African-American males: Racial biases mean that more African-American females end up in detention. Therefore, fewer of them are very dysfunctional and engaging in drug risk behaviors.
  • Among those males in the youngest age group (10 to 13 years), 62.0 percent had vaginal sex, 69.0 percent used alcohol and 76.1 percent used marijuana. Of the males 16 and older, 98.0 percent had vaginal sex, 91.4 percent used alcohol and 96.5 percent used marijuana.
  • Among females in the youngest age group (10 to 13 years), 42.8 percent had vaginal sex, 80.4 percent used alcohol and 68.7 percent used marijuana. Of the females 16 and older, 79.3 percent had vaginal sex, 93.6 used alcohol and 93.8 percent used marijuana.

Results

The project director notes that the baseline research, which highlights the problems of youth detainees, has been cited in the Report of the Surgeon General's Conference on Children's Psychiatric Health: A National Action Agenda (2000), in amicus briefs for the Supreme Court and in Congressional hearings. (Amicus briefs are filed by non-directly involved parties to provide information about the effect of a case.)

Limitations

The project director noted limitations to the research findings:

  • The study sample included only urban juvenile detainees and, thus, is only generalizable to similar populations.
  • Data are self-reported and are subject to the limitations of self-report (potential inaccuracy, socially acceptable but incorrect responses, etc.)

Communications

The project team reported findings from their baseline interviews in three articles in Archives of General Psychiatry, an article in the American Journal of Public Health and articles in the Journal of the American Academy of Child and Adolescent Psychiatry, Psychiatric Services and Pediatrics.

The team also reported findings in three OJJDP Juvenile Justice Bulletins (two in press) and one OJJDP Fact Sheet, published by the Office of Juvenile Justice and Delinquency Prevention at the U.S. Department of Justice; an index of the publications is available online.

Project staff made presentations about the project at the 16th Annual Research Conference sponsored by the Research and Training Center for Children's Mental Health and at the Beyond the Clinic Walls conference in March 2003 cosponsored by the National Institute on Drug Abuse, the National Institute of Mental Health and the National Institute on Alcohol Abuse and Alcoholism and at the National Institute of Justice and the National Institute of Mental Health in May 2003.

The researchers plan to post the baseline data to the Inter-University Consortium for Political and Social Research at the University of Michigan in 2005. Information about the project is available on the Web site of Northwestern University. See Bibliography for details on publications.

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LESSONS LEARNED

The project offered two lessons related to maintaining a highly diverse and mobile sample, one not often captured in longitudinal studies.

  1. To successfully track this population longitudinally requires the cooperation of an interdisciplinary group of scholars and public servants. The project team has conducted research in Cook County, Ill., since 1975 and has cordial relationships with state and county agencies and officials. (Project Director)
  2. Successful tracking also requires access to information from agencies that provide services to, or come into contact with study participants. It is critical to set up a reciprocal relationship with agencies and to highlight how they will benefit, most importantly by receiving information pertaining to their population, at no cost to the agency. (Project Director)

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AFTER THE GRANT

The project team continues to conduct follow-up interviews of study participants and to analyze the resulting data. A Robert Wood Johnson Clinical Scholar is involved in the data analysis. The Robert Wood Johnson Clinical Scholars Program® allows young physicians committed to clinical medicine to acquire new skills and training in the nonbiological sciences important to medical care systems. For more information on the program, see the University of North Carolina Web site and the Grant Results. The team plans several articles reporting the follow-up findings for submission to peer reviewed journals.

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GRANT DETAILS & CONTACT INFORMATION

Project

Continuation of a Longitudinal Study of Substance-Abusing Youthful Offenders

Grantee

Northwestern University Medical School (Chicago,  IL)

  • Amount: $ 749,905
    Dates: July 2001 to June 2003
    ID#:  041942

Contact

Linda A. Teplin, Ph.D.
(312) 503-3500
L-teplin@northwestern.edu

Web Site

http://www.psycho-legal.northwestern.edu/about

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Funders of the Northwestern Juvenile Project

Major Funding

National Institute of Mental Health
Division of Services and Intervention Research and
Center for Mental Health Research on AIDS
National Institutes of Health
Bethesda, Md.

Office of Juvenile Justice and Delinquency Prevention
Office of Justice Programs
U.S. Department of Justice
Washington, D.C.

Center for Mental Health Services
Substance Abuse and Psychiatric Health Services Administration
Rockville, Md.

National Institute on Drug Abuse
National Institutes of Health
Bethesda, Md.

Centers for Disease Control and Prevention
National Center for Injury Prevention and Control and
National Center for HIV, STD and TB Prevention
Atlanta, Ga.

National Institute on Alcohol Abuse and Alcoholism
National Institutes of Health
Bethesda, Md.

Center for Substance Abuse Prevention
Substance Abuse and Mental Health Services Administration
Rockville, Md.

Office of Research on Women's Health
National Institutes of Health
Bethesda, Md.

Office on Rare Diseases
National Institutes of Health
Bethesda, Md.

National Center on Minority Health and Health Disparities
National Institutes of Health
Bethesda, Md.

Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration
Rockville, Md.

The Robert Wood Johnson Foundation
Princeton, N.J.

William T. Grant Foundation
New York, N.Y.

Additional Funding

The John D. and Catherine T. MacArthur Foundation
Chicago, Ill.

Open Society Institute
New York, N.Y.

The Chicago Community Trust
Chicago, Ill.


Appendix 2

Prior Related RWJF Grants

ID#s 019439, 020568 and 028726: Longitudinal Study of Families to Determine Health Outcomes in Adulthood. See Grant Results on ID# 028276.

ID#s 029632 and 034782: Dissemination of Results from the National Longitudinal Study of Adolescent Health. See Grant Results on ID# 029632.

ID# 031890: Follow-Up Study on Adolescent Girls' Tobacco Use. See Grant Results on ID# 031890.

ID# 031925: Research on the Psychosocial Risk Factors for Regular Tobacco Use. See Grant Results on ID# 031925.

ID# 039098: Understanding the Impact of Adult and Parental Smoking Behavior on Youth Smoking Behavior.


Appendix 3

Additional Information on Methodology

Sample
The study participants include a random sample of 1,829 youth originally arrested and detained between 1995 and 1998 in the Cook County, Ill., Temporary Detention Center. The sample was 64.1 percent male and 35.9 percent female; 56.3 percent African American, 25.4 percent Hispanic, 18.2 percent non-Hispanic White and 0.2 percent other race. The large size of gender and racial sub-groups allowed comparison among these sub-groups. Participants ranged in age from 10 to 18 years at baseline.

Interviews
Baseline interviews took place within two days of initial intake at the detention center, between November 1995 and June 1998, and subsequently on the anniversary of that date, three and four and one-half years later. In addition, researchers also re-interviewed a subsample of 1,000 youth at three and one-half and four years after baseline in order to track their experience every six months. Interviewers use the Diagnostic Interview Schedule for Children (DISC), version 2.3 at all interviews. The DISC assesses the presence of disorders in the past six months. Interviewers collect additional data using the following instruments: Children's Global Assessment Scale (CGAS), the Columbia Impairment Scale (CIS) and the Child and Adolescent Services Assessment-Modified (CASA-M). Interviewers of the HIV/AIDS sub-sample employed the AIDS Risk Behavior Assessment.

Additional Data
In addition to the interviews, researchers collect data from official records and participants give urine samples for drug testing at each interview. Researchers also obtain information, such as names and addresses of friends and relatives, so that contact could be maintained with participants over time.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Abram KM, Teplin LA, Charles DR, Longworth SL, McClelland GM and Dulcan MK. "Posttraumatic Stress Disorder and Trauma in Youth in Juvenile Detention." Archives of General Psychiatry, 61(4): 403–410, 2004. Abstract available online.

Abram KM, Teplin LA, McClelland GM and Dulcan MK. "Comorbid Psychiatric Disorders in Youth in Juvenile Detention." Archives of General Psychiatry, 60(11): 1097–1108, 2003. Abstract available online.

McClelland GM, Elkington KS, Teplin LA and Abram KM. "Multiple Substance Use Disorders in Juvenile Detainees." Journal of the American Academy of Child & Adolescent Psychiatry, 43(10): 1215–1224, 2004. Abstract available online.

Teplin LA, Abram KM, McClelland GM, Dulcan MK and Mericle AA. "Psychiatric Disorders in Youth in Juvenile Detention." Archives of General Psychiatry, 59(12): 1133–1143, 2002. Abstract available online.

Teplin LA, Elkington KS, McClelland GM, Abram KM, Mericle AA and Washburn JJ. "Major Mental Disorders, Substance Use Disorders, Comorbidity, and HIV-AIDS Risk Behaviors in Juvenile Detainees." Psychiatric Services, 56(7): 823–828, 2005. Abstract available online.

Teplin LA, McClelland GM, Abram KM and Mileusnic D. "Early Violent Death Among Delinquent Youth: A Prospective Longitudinal Study." Pediatrics, 115, 1586–1593, 2005. Abstract available online.

Teplin LA, Mericle AA, McClelland GM and Abram KM. "HIV and AIDS Risk Behaviors in Juvenile Detainees: Implications for Public Health Policy." American Journal of Public Health, 93(6): 906–912, 2003.

Reports

McClelland GM, Teplin LA and Abram KM. Detection and Prevalence of Substance Use Among Juvenile Detainees (OJJDP Juvenile Justice Bulletin). Washington: Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice, June 2004. Also available online. A PDF version is also available at the index of publications.

Teplin LA. Assessing Alcohol, Drug, and Mental Disorders in Juvenile Detainees (OJJDP Fact Sheet). Washington: Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice, 2001. Also available online. A PDF version is also available at the index of publications.

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Report prepared by: Mary B. Geisz
Reviewed by: Kelsey Menehan
Reviewed by: Molly McKaughan
Program Officer: M. Katherine Kraft