It may be time for U.S. to explore alternatives for wayward youths, studies suggest
By Amy Norton
MONDAY, Jan. 23, 2017 (HealthDay News) -- Young people in juvenile detention or jail may suffer health effects that last well into adulthood, a pair of new studies suggests.
Together, they suggest incarcerated teens will face higher rates of depression, worse physical health, and a greater risk of sexually transmitted diseases, compared to other young Americans.
Experts said the studies highlight a little-recognized fact: Youth incarceration is a public health problem.
The United States has the highest rate of "youth confinement" of any developed country, according to the advocacy group Campaign for Youth Justice. In 2013, out of every 100,000 minors, 173 were in confinement nationwide.
"Juvenile incarceration is its own hidden epidemic," said Ralph DiClemente of Emory University in Atlanta.
DiClemente, a professor of public health, wrote an editorial accompanying the studies, published online Jan. 23 in the journal Pediatrics.
But until now, DiClemente said, little had been known about the long-term health of young people who move through the justice system.
The new findings, he said, "show us that these young people have myriad health problems and risk behaviors, and that continues into adulthood."
In one study, researchers focused on more than 1,800 young people who had spent time in Chicago juvenile detention centers. Fourteen years later, those children -- now around age 30 -- had much higher-than-average odds of risky sexual behavior, such as having multiple partners within a few months.
In the other study, researchers used data from a government survey tracking the health of more than 14,000 Americans -- starting in middle school or high school, and continuing up to age 34.
During that time, 14 percent ended up in juvenile detention or jail by age 24.
Overall, the study found, incarcerated young people showed more health problems between the ages of 24 and 34, versus other Americans their age.
Close to one-quarter -- 23 percent -- had depression symptoms, compared with 15 percent of other study participants. More than 52 percent rated their general health as no better than "fair," compared with 41 percent.
Of course, young people who end up in jail have many other things going on in their lives that could take a toll on their health, too.
And it's difficult to weed out the effects of incarceration itself, said study leader Dr. Elizabeth Barnert.
"It's a mess, and we can't say that this is causal," said Barnert, an assistant professor of pediatrics at the University of California, Los Angeles.
But her team did account for a number of other factors, including race, income and parents' education levels.
And incarcerated kids still showed higher long-term risks -- especially if they'd been confined for more than one year.
According to Barnert, young people may actually get certain benefits during their time in detention -- namely, access to health care. But, in the long run, she said, incarceration probably has negative consequences.
"Is it a direct effect of incarceration? Is it because they can't get a job afterward? Is it the psychological effects and how you view yourself afterward?" Barnert said. "We don't know."
What is clear, she and DiClemente said, is that kids and young adults in the justice system are "vulnerable." And they return to the community with largely unmet health care and social needs.
DiClemente said there is a "window of opportunity" while young people are incarcerated, when they can be screened for health problems and risky behavior. To an extent, he said, that's happening: Kids may be screened and treated for a sexually transmitted disease, for example.
"But what's not done very well is risk-behavior reduction," DiClemente said. "What happens when they go back to their communities?"
There are no easy answers, he and Barnert said.
Ultimately, "system-level reform" has to become a priority -- as it has in Georgia, said DiClemente.
The state is implementing the Juvenile Detention Alternatives Initiative, a project of the nonprofit Annie E. Casey Foundation. It promotes alternatives to locking kids up -- such as home confinement, day and evening reporting centers and shelter care.
Around 300 U.S. counties have started the program, according to the Casey Foundation. And, the group says, those places have seen "dramatic" reductions in the number of kids in detention centers -- with no signs of harming public safety.
"We don't want to relegate these kids to a life where they're not going to be able to reach their full potential," DiClemente said. "This is a social issue. It's a public health issue."
Barnert pointed to the well-documented racial disparities in Americans' health and involvement with the justice system.
Black men are far more likely than whites to be incarcerated at some point. And that, Barnert said, may contribute to racial disparities in health as well.
The Annie E. Casey Foundation has more on juvenile justice.
SOURCES: Elizabeth Barnert, M.D., M.P.H., assistant professor, pediatrics, University of California, Los Angeles; Ralph DiClemente, Ph.D., professor, public health, Rollins School of Public Health, Emory University, Atlanta; Jan. 23, 2017, Pediatrics, online
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