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Figure 1.
Sex Differences in the Prevalence of Positive Outcomes 5 and 12 Years After Detention
Sex Differences in the Prevalence of Positive Outcomes 5 and 12 Years After Detention

For each positive outcome, the figure shows prevalence among males (circles) and females (diamonds) and associated 95% CIs. The column on the left indicates the corresponding odds ratios (ORs) and associated 95% CIs comparing females with males.
aEducational attainment excludes participants who were younger than 18 years at the time of the interview.
bParenting responsibility excludes participants who did not have any children at the time of the interview.

Figure 2.
Racial/Ethnic Differences in the Prevalence of Positive Outcomes Among Males 5 and 12 Years After Detention
Racial/Ethnic Differences in the Prevalence of Positive Outcomes Among Males 5 and 12 Years After Detention

For each positive outcome, the figure shows prevalence among African American (AA) males (squares), Hispanic (H) males (circles), and non-Hispanic white (W) males (triangles) and associated 95% CIs. The columns on the left indicates the corresponding odds ratios (ORs) and associated 95% CIs comparing racial/ethnic groups.
aEducational attainment excludes participants who were younger than 18 years at the time of the interview.
bParenting responsibility excludes participants who did not have any children at the time of the interview.

Figure 3.
Racial/Ethnic Differences in the Prevalence of Positive Outcomes Among Females 5 and 12 Years After Detention
Racial/Ethnic Differences in the Prevalence of Positive Outcomes Among Females 5 and 12 Years After Detention

For each positive outcome, the figure shows prevalence among African American (AA) females (squares), Hispanic (H) females (circles), and non-Hispanic white (W) females (triangles) and associated 95% CIs. The columns on the left indicates the corresponding odds ratios (ORs) and associated 95% CIs comparing racial/ethnic groups.
aEducational attainment excludes participants who were younger than 18 years at the time of the interview.
bParenting responsibility excludes participants who did not have any children at the time of the interview.

Table 1.  
Definitions and Measures of Positive Outcome by Domain
Definitions and Measures of Positive Outcome by Domain
Table 2.  
Latent Class Models of Positive Outcomes 12 Years After Detentiona,b
Latent Class Models of Positive Outcomes 12 Years After Detentiona,b
Supplement.

eAppendix. Expanded Notes on Study Methods

eTable 1. Demographic Characteristics, 5 Years and 12 Years After Detention

eTable 2. Prevalence of Positive Outcomes, 5 Years and 12 Years After Detention: Sex Differences

eTable 3. Prevalence of Positive Outcomes, 5 Years and 12 Years After Detention Among Males: Racial/Ethnic Differences

eTable 4. Prevalence of Positive Outcomes, 5 Years and 12 Years After Detention Among Females: Racial/Ethnic Differences

eTable 5. Consistency in the Achievement of Positive Outcomes 5 and 12 Years After Detention: Sex Differences

eTable 6. Prevalence of Positive Outcomes, 5 Years and 12 Years After Detention, Among Those Living in the Community: Sex Differences

eTable 7. Prevalence of Positive Outcomes, 5 Years and 12 Years After Detention Among Males Living in the Community: Racial/Ethnic Differences

eTable 8. Prevalence of Positive Outcomes, 5 Years and 12 Years After Detention Among Females Living in the Community: Racial/Ethnic Differences

eTable 9. Difference in Mean Counts of Positive Outcomes Between 5 Years After Detention and 12 Years After Detention, by Sex and Race/Ethnicity

eTable 10. Latent Class Membership Among Males: Racial/Ethnic Differences

eFigure 1. Consistency in the Achievement of Positive Outcomes 5 and 12 Years After Detention: Males

eFigure 2. Consistency in the Achievement of Positive Outcomes 5 and 12 Years After Detention: Females

eFigure 3. Prevalence of Total Counts of Positive Outcomes: Sex Differences

eFigure 4. Prevalence of Total Counts of Positive Outcomes Among Males: Racial/Ethnic Differences

eFigure 5. Prevalence of Total Counts of Positive Outcomes Among Females: Racial/Ethnic Differences

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Original Investigation
February 2017

Sex and Racial/Ethnic Differences in Positive Outcomes in Delinquent Youth After Detention: A 12-Year Longitudinal Study

Author Affiliations
  • 1Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
 

Copyright 2016 American Medical Association. All Rights Reserved.

JAMA Pediatr. 2017;171(2):123-132. doi:10.1001/jamapediatrics.2016.3260
Key Points

Questions  Do delinquent youth attain age-appropriate psychosocial outcomes in young adulthood after detention, and do outcomes vary by sex and race/ethnicity?

Findings  This 12-year longitudinal study of 1829 delinquent youth found that, 12 years after detention, only 21.9% of males and 54.7% of females had achieved more than half of the 8 positive psychosocial outcomes examined. Minority males, particularly African Americans, were the least likely to achieve age-appropriate milestones.

Meaning  To improve outcomes for youth after detention, pediatric health care professionals should recognize the importance of psychosocial health, partner with on-site psychosocial services in their practices, and facilitate access to services in the community.

Abstract

Importance  Longitudinal studies of delinquent youth have focused on criminal recidivism, not on psychosocial outcomes in adulthood. This omission is critical because after detention most youth return to the community, where they become the responsibility of pediatric health care professionals.

Objective  To investigate 8 positive outcomes among delinquent youth 5 and 12 years after detention, focusing on sex and racial/ethnic differences.

Design, Setting, and Participants  In the Northwestern Juvenile Project, a longitudinal US study of long-term outcomes of delinquent youth after detention, participants were interviewed in detention between November 20, 1995, and June 14, 1998, and reinterviewed up to 9 times during the 12-year study period, through May 12, 2011. Data analysis was conducted between November 18, 2013, and July 25, 2016.

Exposures  Juvenile detention.

Main Outcomes and Measures  Achievement of positive outcomes in 8 domains: educational attainment, residential independence, gainful activity, desistance from criminal activity, mental health, abstaining from substance abuse, interpersonal functioning, and parenting responsibility. Outcomes were assessed with widely used measures supplemented by correctional records.

Results  The study included 1829 youth at baseline (1172 males and 657 females; mean [SD] age, 14.9 [1.4] years). At the end of the study, 1520 (83.1%) of the original sample remained (944 males and 576 females; mean [SD] age, 27.6 [1.4] years). Twelve years after detention, females were more likely than males to have positive outcomes for gainful activity (odds ratio [OR], 2.53; 95% CI, 1.86-3.44), desistance from criminal activity (OR, 5.89; 95% CI, 4.38-7.92), residential independence (OR, 3.41; 95% CI, 2.57-4.52), parenting responsibility (OR, 18.65; 95% CI, 12.29-28.30), and mental health (OR, 1.48; 95% CI, 1.13-1.92). Twelve years after detention, only 21.9% of males and 54.7% of females had achieved more than half of the outcomes. As youth aged, the number of positive outcomes increased only modestly (mean increase for males, 0.37; 95% CI, 0.13-0.62; for females, 0.29; 95% CI, 0.13-0.45). Among males, non-Hispanic white individuals were significantly more likely to achieve most positive outcomes compared with minorities, but less likely to abstain from substance abuse. For example, 12 years after detention, non-Hispanic white males had nearly 3 times the odds of educational attainment compared with African American (OR, 2.82; 95% CI, 1.77-4.50) and Hispanic males (OR, 2.91; 95% CI, 1.75-4.82), and 2 to 5 times the odds of gainful activity compared with African American (OR, 5.17; 95% CI, 3.16-8.45) and Hispanic males (OR, 2.58; 95% CI, 1.56-4.26). Latent class analysis shows that African American males fared the worst, with lives characterized by incarceration, criminal activity, and few positive outcomes.

Conclusions and Relevance  Our findings highlight racial/ethnic disparities among youth in achieving positive outcomes after detention. To improve outcomes, pediatric health care professionals should recognize the importance of psychosocial health, partner with on-site psychosocial services in their practices, and facilitate access to services in the community.

Introduction

The United States has the highest rate of incarceration of any developed country.1 Each year, approximately 1.5 million youth are arrested.2 More than 54 000 juveniles, disproportionately racial/ethnic minorities, were incarcerated on an average day in 2013.3 Nearly all these youth eventually return to their communities after incarceration.

Delinquent youth are at great risk for poor outcomes in adulthood, having limited social support,4 adult guidance,4 educational attainment,5 and cognitive resources.6 The stigma of prior criminality limits opportunities for employment.7 Moreover, the experience of incarceration may impair psychosocial development.8,9

Despite these adversities, some delinquent youth desist from crime, pursue an education, and become employed. However, little is known about positive outcomes among youth after detention. The most comprehensive study, which was conducted in England, has limited generalizability to addressing health disparities in the United States.10 Investigations conducted in the United States also have limitations. The classic Glueck and Glueck study,11-13 which was conducted in the 1940s, examined a variety of outcomes, but did not include racial/ethnic minorities (who now comprise two-thirds of US juvenile detainees3). More recent studies also have unrepresentative samples, examining only serious or adjudicated (convicted) offenders,14-16 who represent a fraction of youth in the juvenile justice system. One study oversampled youth referred to group homes and sentenced to drug treatment, further reducing generalizability.15 Finally, studies have examined outcomes only until the participants were in their early 20s14-16 and assessed only recidivism and gainful activity.16,17

These omissions are critical. Hispanics, now the largest minority group in the United States,18 are disproportionately confined in several states.19 Disproportionate minority confinement especially affects African American males, who comprise approximately 17% of youth in the United States20 but 40% of youth in correctional facilities.3 Data on females are needed because they are a growing proportion of youth in the juvenile justice system, comprising 27.9% of youth processed in juvenile court and 13.6% of incarcerated youth.3 Data on positive outcomes of delinquent youth will inform the development of sex-specific preventive interventions and address racial/ethnic health disparities.

To our knowledge, this is the first comprehensive US study of long-term outcomes of delinquent youth after detention. Using data from the Northwestern Juvenile Project, we examined the achievement of positive outcomes in 8 domains: educational attainment, residential independence, gainful activity, desistance from criminal activity, mental health, abstaining from substance abuse, interpersonal functioning, and parenting responsibility. We examine the prevalence of specific outcomes 5 and 12 years after detention (at median ages 20 and 28 years, respectively), focusing on sex and racial/ethnic differences; overall counts of positive outcomes; and common patterns of outcomes, using a latent class analysis.

Methods

For all interviews, participants signed either an assent form (if they were <18 years) or a consent form (if they were ≥18 years). The Northwestern University Institutional Review Board and the Centers for Disease Control and Prevention Institutional Review Board approved all study procedures and waived parental consent for persons younger than 18 years, consistent with federal regulations regarding research with minimal risk.21 We nevertheless attempted to contact parents of minors to obtain their consent and to provide them with information on the study and used an independent participant advocate to represent the minors’ interests.

Sample, Procedures, and Measures

We recruited a stratified random sample of 1829 youth at intake to the Cook County Juvenile Temporary Detention Center in Chicago, Illinois, between November 20, 1995, and June 14, 1998 (additional information is available in the eAppendix in the Supplement and is published elsewhere22). The Cook County Juvenile Temporary Detention Center is used for pretrial detention and for offenders sentenced for fewer than 30 days. Consistent with data on juvenile detainees nationwide,3,23 nearly 90% of detainees at the Cook County Juvenile Temporary Detention Center were male; most were racial/ethnic minority youth. To ensure adequate representation of key subgroups, we stratified our sample by sex, race/ethnicity (African American, non-Hispanic white, Hispanic, or other), age (10-13 years or 14-18 years), and legal status (processed in juvenile or adult court). Face-to-face structured interviews were conducted at the detention center in a private area, most within 2 days of intake. The stratified random sample included 1172 males and 657 females (1005 African American, 524 Hispanic, 296 non-Hispanic white, and 4 of other race/ethnicity). At baseline, youth had a median age of 15 years (mean [SD], 14.9 [1.4] years).

We conducted follow-up interviews at approximately 3, 5, 6, 8, and 12 years after the baseline interview (hereafter referred to as after detention) for the entire sample; subsamples were interviewed more frequently. The last 12-year interview was conducted May 12, 2011. Participants were interviewed whether they lived in the community or in correctional facilities. We present outcomes at 2 time points, which, for simplicity, we refer to as 5 and 12 years after detention. As in prior work,22 the 5-year time point consists of 1561 participants (85.3%) who were interviewed a mean (SD) of 4.9 (0.4) years after detention (median, 4.7 years). The 12-year time point consists of 1520 participants (83.1%) who were interviewed a mean (SD) of 12.3 (0.3) years after detention (median, 12.2 years). eTable 1 in the Supplement summarizes demographics and retention at 5 and 12 years after detention, when participants were median ages 20 and 28 years, respectively. Table 1 shows definitions and measures for the 8 positive outcomes at the 5- and 12-year follow-ups.24-33

Statistical Analysis

Data analysis was conducted from November 18, 2013, to July 25, 2016. All analyses were conducted using STATA statistical software, version 12 (StataCorp) with its survey routines. To generate prevalence estimates and inferential statistics that reflect the population of the Cook County Juvenile Temporary Detention Center, each participant was assigned a sampling weight augmented with a nonresponse adjustment to account for missing data. Because minorities are disproportionately incarcerated, weighted estimates for males and females overall are similar to those for African American males and females.

We present prevalence estimates for participants who were still living at follow-up. (Five and 12 years after detention, 50 and 97 participants had died, respectively.)34,35 Because incarceration prevents people from achieving many positive outcomes, we also present prevalence only for participants living in the community during the recall period (eAppendix in the Supplement). We used logistic regression to examine sex and racial/ethnic differences in outcomes, adjusting for age at detention and legal status. We used the Latent Class Analysis Stata plugin36 to empirically identify classes of participants who exhibited similar patterns of positive outcomes 12 years after detention. Three participants who self-identified as other race/ethnicity were excluded from all analyses. We conducted separate analyses for males and females because combining them could obfuscate important differences.

Results
Prevalence of Positive Outcomes in Specific Domains

Figure 1 illustrates the prevalence of positive outcomes, as well as differences between the sexes on the outcomes, 5 and 12 years after detention. Figure 2 and Figure 3 show racial/ethnic differences in positive outcomes among males and females, respectively, as do eTables 2-4 in the Supplement. eFigures 1 and 2 and eTable 5 in the Supplement show the prevalence of achieving positive outomes at both time points.

Sex Differences

Five years after detention, females were more likely than males to have positive outcomes in every domain except abstaining from substance abuse (odds ratio [OR], 0.90; 95% CI, 0.68-1.19); the largest sex differences were in desistance from criminal activity (OR, 9.81; 95% CI, 6.90-13.94), residential independence (OR, 8.52; 95% CI, 5.99-12.11), and parenting responsibility (OR, 5.08; 95% CI, 2.92-8.84). Twelve years after detention, there were fewer sex differences; however, females were still more likely than males to have most positive outcomes. Notably, 67.7% of females had desisted from criminal activity compared with 26.9% of males (OR, 5.89; 95% CI, 4.38-7.92); 84.4% of females had a positive outcome in parenting responsibility compared with 23.9% of males (OR, 18.65; 95% CI, 12.29-28.30). Females were more likely than males to have positive outcomes at both time points for educational attainment (OR, 1.89; 95% CI, 1.28-2.79), desistance from criminal activity (OR, 8.15; 95% CI, 4.76-13.97), interpersonal functioning (OR, 1.96; 95% CI, 1.22-3.14), residential independence (OR, 7.92; 95% CI, 4.58-13.71), parenting responsibility (OR, 2.62; 95% CI, 1.11-6.19), and mental health (OR, 2.02; 95% CI, 1.32-3.07) (eTable 5 in the Supplement).

Racial/Ethnic Differences
Males

Non-Hispanic white individuals were more likely than African American and Hispanic individuals to have positive outcomes in many domains, especially at the 12-year follow-up (Figure 2). For example, 12 years after detention, non-Hispanic white individuals had more than 5 times the odds of gainful activity than African American (OR, 5.17; 95% CI, 3.16-8.45) and more than 2 times the odds of Hispanic individuals (OR, 2.58; 95% CI, 1.56-4.26). However, 12 years after detention, African American individuals and Hispanic individuals were more likely to be abstaining from substance abuse compared with non-Hispanic white individuals (non-Hispanic white vs African American: OR, 0.52; 95% CI, 0.33-0.80; non-Hispanic white vs Hispanic: OR, 0.45; 95% CI, 0.28-0.73).

Females

There were far fewer racial/ethnic differences among females at either time point (Figure 3). Notably, as with males, non-Hispanic white females had greater odds of educational attainment than minorities at 5 years (non-Hispanic white vs African American: OR, 1.98; 95% CI, 1.17-3.34; non-Hispanic white vs Hispanic: OR, 1.98; 95% CI, 1.05-3.73) and 12 years (non-Hispanic white vs African American: OR, 1.93; 95% CI, 1.10-3.40; non-Hispanic white vs Hispanic: OR, 1.64; 95% CI, 0.86-3.14).

Positive Outcomes Among Persons Living in the Community

Because incarceration prevents people from achieving some of the outcomes assessed (Table 1), we also examined sex and racial/ethnic differences only among participants who lived in the community during the entire recall period. Findings were substantially similar (eTables 6-8 in the Supplement).

Counts of Positive Outcomes

eFigure 3 in the Supplement shows sex differences in the total counts of positive outcomes 5 years after detention (males, 2.79; 95% CI, 2.60-2.98; females, 4.35; 95% CI, 4.20-4.50) and 12 years after detention (males, 3.16; 95% CI, 2.99-3.34; females, 4.63; 95% CI, 4.48-4.78). The number of positive outcomes increased only modestly (males, 0.37; 95% CI, 0.13-0.62; females, 0.29; 95% CI, 0.13-0.45) between 5 and 12 years (eTable 9 in the Supplement). Twelve years after detention, 21.9% of males and 54.7% of females had achieved more than half of the outcomes (5 or more); only 11.1% of males and 35.0% of females had achieved 6 or more positive outcomes. At both time points, females had more positive outcomes than males: at 5 years, the mean difference was 1.56 (95% CI, 1.31-1.80); at 12 years, the mean difference was 1.47 (95% CI, 1.23-1.70).

eFigures 4 and 5 in the Supplement show racial/ethnic differences in the total counts of positive outcomes for males and females, respectively. Among males 12 years after detention, 45.8% of non-Hispanic white individuals had achieved more than half of the outcomes, compared with only 28.7% of Hispanic individuals and only 19.0% of African American individuals. Non-Hispanic white males had more positive outcomes than minority males: at 5 years, the mean difference was 1.03 (95% CI, 0.67-1.40) vs African American males and 0.88 (95% CI, 0.45-1.31) vs Hispanic males. At 12 years, the differences were 1.26 (95% CI, 0.90-1.62) and 0.86 (95% CI, 0.45-1.27), respectively. Among females, there were no significant racial/ethnic differences.

Patterns of Positive Outcomes

We used latent class analyses to empirically identify classes of participants who exhibited similar patterns of positive outcomes 12 years after detention. Table 2 shows the percentage of participants in each class for males and females, the probability of attaining a particular positive outcome in each class, and the racial/ethnic distribution and incarceration characteristics of each class. Among males, we found the following 5 classes, which we called: (1) poor overall functioning (24.4%): unlikely to have positive outcomes in any domain; (2) incarcerated (28.1%): positive outcome in only 1 domain, abstaining from substance abuse; (3) living independently but struggling (20.7%): positive outcomes in only 1 domain, residential independence; (4) family men but struggling (5.9%): high probability of achieving interpersonal functioning, parenting responsibility, and abstaining from substance abuse; and (5) functioning independently (21.0%): likely to attain positive outcomes in nearly all domains. Among males who had been incarcerated in the past year, 81.0% were in the poorest functioning classes (classes 1-3) (Table 2). Minorities, especially African American individuals, were overrepresented in the classes with the fewest positive outcomes (classes 1-3) (eTable 10 in the Supplement).

Among females, we found the following 4 classes, which we called: (1) unstable mothers (14.4%): positive outcomes in only 1 domain, parenting responsibility; (2) substance free but struggling (10.1%): positive outcomes in only 1 domain, abstaining from substance abuse; (3) at-home mothers (59.9%): especially likely to be positive in parenting responsibility, desistance from criminal activity, and residential independence, but unlikely to be positive in gainful activity or interpersonal functioning; and (4) positive overall functioning (15.6%): likely to have positive outcomes in every domain except interpersonal functioning. Among females who had been incarcerated in the past year, 72.4% were in the poorest functioning classes (classes 1 and 2) (Table 2). There were no racial/ethnic differences.

Discussion

Twelve years after detention, only 1 in 5 males and nearly 1 in 2 females had attained positive outcomes in more than half of the domains assessed, which included gainful activity, educational attainment, interpersonal functioning, and parenting responsibility. Moreover, the numbers of positive outcomes increased only slightly between late adolescence and young adulthood. The socioeconomic picture was bleak. Only half of the participants had a high school degree or its equivalent, a rate substantially lower than among comparably aged persons nationwide (88.4%).37,38 Only one-fifth of males and approximately one-third of females in our sample were working full time or in school. In contrast, 77% of the general population is socioeconomically self-sufficient by ages 29 to 30 years39; in 1 study, 67% of males and 52% of females aged 22 to 32 years were employed full-time in 2011-2013.40

To our knowledge, our study is the first to document the dearth of long-term positive outcomes in multiple domains among delinquent youth after detention. Outcomes are even poorer than those in a study by Ramchand and colleagues,15 which found that 7 years later (age 20-24 years), 58% of serious offenders sampled from group homes had completed high school or its equivalent, and 32% were employed full time.

Why do the females in this study function substantially better than the males in nearly every domain? First, delinquency among females is largely confined to adolescence.41 Even in the general population, males are more likely than females to have static and enduring risk factors for delinquent behavior, such as nervous system dysfunctions, difficult temperaments, delayed achievement of verbal and motor milestones, and hyperactivity.41,42 Males’ more extensive involvement with correctional systems during the transition to adulthood limits opportunities to achieve adult roles, such as employment.

Second, delinquent females are more likely than males to be involved in prosocial activities and relationships.43 Prosocial involvement, including parenting, is critical to positive functioning. In our study, females were more than 18 times more likely to be parenting their children than were males.

The latent class analysis demonstrated that African American males fared the worst, with lives characterized by incarceration, criminal activity, and few positive outcomes. Hispanic males functioned more poorly overall than non-Hispanic white males. Racial/ethnic disparities among delinquent youth appear to be even greater than disparities in the general population.44 The cycle of disadvantage may be most profound for racial/ethnic minorities,45 who have fewer resources and opportunities to fulfill adult responsibilities.

Limitations

Our data are subject to the limitations of self-report. Generalizability may be limited to youth in urban detention centers with similar sociodemographic characteristics. We did not control for social class because nearly all youth who enter detention are poor. Participants lost to follow-up may have biased the sample. Of course, we could not examine the outcomes of deceased participants; however, including them in computations (defined as negative on all outcomes) did not alter findings substantially (eAppendix in the Supplement). Outcome data are a snapshot of functioning at 2 time points. Although counts of positive outcomes provide a useful summary of overall functioning, their utility is limited because it gives equal weight to each outcome. We likely overestimated residential independence at 12 years because we were unable to determine the number of householders in our sample as defined by the US Census Bureau (whether participants’ residences were legally in their name).46 To define gainful activity, we followed the decision rules set forth by the US Department of Labor that defines full-time homemakers as unemployed. Although homemakers would not score a positive outcome in this category, they could score as positive in parenting responsibility. Although this decision could make females appear to have poorer outcomes, they actually had better outcomes than males. Finally, detention is the outcome of multiple risk factors and developmental processes. We cannot determine that detention caused poor outcomes independent of those risk factors.

Implications
Expansion of Services for Delinquent Youth, Focusing on Minority Males

Our findings demonstrate that programs must be improved for males, who, based on US Department of Justice statistics, comprise 72% of cases handled by juvenile courts47 and 86% of youth in residential placement.3 Although reentry programs that focus on reducing criminal recidivism are critical for public safety, other needs of delinquent youth must be addressed. To improve outcomes, pediatric health care professionals should recognize the importance of psychosocial health, partner with on-site psychosocial services in their practices, and facilitate access to services in the community.48 Programs are most effective when they implement services flexibly, based on individual need and developmental stage.4

Providing services for delinquent males is challenging. Compared with females, males may be less amenable to intervention for delinquent behavior; they generally have lower levels of interpersonal agreeableness,42 greater susceptibility to deviant peer influence,49 and, in many cases, longer histories of oppositional behavior and aggression.50 Moreover, adolescent males are less likely than females to seek mental health services,51 and their mental health needs are less likely to be detected in correctional settings.52 Racial/ethnic minorities are even less likely to receive services than are non-Hispanic white individuals.53

Despite these challenges, expanding services may improve the outcomes of many racial/ethnic minority males who have been incarcerated. The potential effect cannot be overstated. The US Department of Justice estimates that among infants born in 2001, a total of 1 in 3 African American males and 1 in 6 Hispanic males will be incarcerated in a state or federal prison at some point during their lifetime.54

Support for Policies That Reduce Collateral Consequences of Criminal Records

Delinquent youth have many risk factors that reduce the likelihood of positive outcomes.4-6 However, involvement with the justice system presents additional obstacles to positive outcomes as youth, especially minorities, age. First, delinquent youth may find it difficult to return to school after release. Many have cognitive deficits6 and low expectations of success.55 Delinquent youth, particularly minorities, experience harsher disciplinary actions than their nondelinquent peers.56,57 Punitive discipline may have the unintended consequence of increasing delinquency and fostering the “school-to-prison pipeline.”58(p287) Second, use of criminal records to make employment decisions impedes hiring of ex-offenders. Finally, in many states, convicted felons may be banned from voting, public housing, admission to colleges and universities, child custody, and public aid.59,60 Convicted felons also may be barred from certain occupations, including working in health care facilities, insurance agencies, hairdressing, and cosmetology.61 These consequences increase the likelihood of recidivism.62

Conclusions

Positive adult outcomes after incarceration are the exception and not the rule, particularly for racial/ethnic minorities. To succeed, delinquent youth must be helped not only to desist from crime but also to overcome barriers to social stability and employment.

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Article Information

Accepted for Publication: August 22, 2016.

Corresponding Author: Linda A. Teplin, PhD, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Dr, Ste 900, Chicago, IL 60611-3078 (healthdisparities@northwestern.edu).

Published Online: December 19, 2016. doi:10.1001/jamapediatrics.2016.3260

Author Contributions: Dr Teplin had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Abram, Azores-Gococo, Emanuel, Welty, Teplin.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Abram, Azores-Gococo, Aaby, Welty, Hershfield, Teplin.

Statistical analysis: Abram, Emanuel, Aaby, Welty, Hershfield, Rosenbaum.

Administrative, technical, or material support: Abram, Hershfield.

Study supervision: Abram, Welty, Teplin.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by grants R01DA019380, R01DA022953, and R01DA028763 from the National Institute on Drug Abuse; grants R01MH54197 and R01MH59463 from the National Institute of Mental Health (Division of Services and Intervention Research and Center for Mental Health Research on AIDS); and grants 1999-JE-FX-1001, 2005-JL-FX-0288, and 2008-JF-FX-0068 from the Office of Juvenile Justice and Delinquency Prevention. Major funding was also provided by the National Institute on Alcohol Abuse and Alcoholism, the National Institutes of Health Office of Behavioral and Social Sciences Research, Substance Abuse and Mental Health Services Administration (Center for Mental Health Services, Center for Substance Abuse Prevention, Center for Substance Abuse Treatment), the National Institutes of Health Center on Minority Health and Health Disparities, the Centers for Disease Control and Prevention (National Center for Injury Prevention and Control and National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention), the National Institutes of Health Office of Research on Women’s Health, the National Institutes of Health Office of Rare Diseases, Department of Labor, Department of Housing and Urban Development, The William T. Grant Foundation, and The Robert Wood Johnson Foundation. Additional funds were provided by The John D. and Catherine T. MacArthur Foundation, The Open Society Institute, and The Chicago Community Trust.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Celia Fisher, PhD, Fordham University, and Mina Dulcan, MD, Ann & Robert Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, provided invaluable advice on the project. Zaoli Zhang, MS, Northwestern University Feinberg School of Medicine, and Lynda Carey, MA, Northwestern University Feinberg School of Medicine, provided data assistance. We thank Cathy Spatz Widom, PhD, John Jay College of Criminal Justice, Wes Skogan, PhD, Northwestern University, and the anonymous reviewers for their helpful comments on the manuscript. We thank our participants for their time and willingness to participate; our talented and intrepid field staff; the Circuit Court of Cook County including the Cook County Juvenile Temporary Detention Center, the Juvenile Justice and Child Protection Department, the Juvenile Probation and Court Services Department, the Social Service Department, Adult Probation, and Forensic Clinical Services; the Cook County Department of Corrections; the Illinois Department of Juvenile Justice; and the Illinois Department of Corrections for their cooperation. Cathy Spatz Widom, PhD, was compensated for her contribution. None of the other contributors were compensated for their contributions.

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