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© 2003 American Public Health Association
RESEARCH AND PRACTICE |
The authors are with the Psycho-Legal Studies Program, The Feinberg School of Medicine, Dept of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Ill.
Correspondence: Requests for reprints should be sent to Linda A. Teplin, PhD, Psycho-Legal Studies Program, 710 N Lakeshore Dr, Suite 900, Chicago, IL 60611 (e-mail: psycho-legal{at}northwestern.edu).
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INTRODUCTION |
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 TOP INTRODUCTION METHODSRESULTSDISCUSSIONReferences |
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HIV and AIDS are increasingly diseases of minorities and the disadvantaged.1,2 These same groups are disproportionately involved in the justice system.3 Detained youths may be at particular risk. Sexually transmitted diseases, related to HIV and AIDS,4–6 are prevalent among detained youths. Moreover, although HIV seropositivity is infrequent among detained youths,4 studies of adult detainees suggest that detained youths are at great risk for developing HIV as they age.7–24
Although researchers have studied HIV and AIDS risk behaviors among detained youths,5,6,25–31 our knowledge is still limited. Few studies used random samples; many used volunteers or referred samples.5,28–30 Some studies excluded females.5,26,30 Only 1 study examined differences by race/ethnicity.31 No study has examined differences by age. Some studies investigated only sexual risk behaviors28,29 or a limited number of sexual and drug risk behaviors.25,27,31
This study had (1) a stratified random sample large enough to compare rates by gender, race/ethnicity, and age and (2) comprehensive measures of sexual and drug HIV and AIDS risk behaviors.
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METHODS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Participants were part of the Northwestern Juvenile Project, a longitudinal study of 1829 youths (aged 10–18 years) initially arrested and detained between 1995 and 1998 at the Cook County Juvenile Temporary Detention Center in Chicago, Ill.32 The random sample was stratified by gender, race/ethnicity, age, and charge severity. We began collecting HIV and AIDS risk data 6 months after the larger study began. The sample size was 800: 340 females and 460 males. The sample included 145 non-Hispanic Whites, 430 African Americans, 223 Hispanics, and 2 youths who self-identified as "other"; 3.9% of the eligible youths refused to participate. Additional information on our methods is published elsewhere.32
Interviewers (master’s level or equivalent) gathered HIV and AIDS risk data with the AIDS Risk Behavior Assessment, compiled from 2 widely used instruments (the National Institute on Drug Abuse Risk Behavior Assessment33 and the Adolescent Health Survey34) and selected items from the Diagnostic Interview Schedule for Children, Version 2.3.35
We reduced the risk of type I error by setting our 
level to .01 and by performing specific tests only when the overall test result was significant.36 We weighted all estimates to reflect the detention center’s population and used Taylor series linearization37,38 to correct tests of inference.
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RESULTS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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We report rates of HIV and AIDS sexual and drug risk behaviors by gender and race/ethnicity (Table 1
) and by gender and age (Table 2).
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Gender
More than 90% of the males were sexually active; 60.8% had more than 1 sexual partner in the last 3 months. Significantly more males than females engaged in many of the examined sexual risk behaviors. Drug risk behaviors were common among both males and females; none, however, varied significantly by gender. More than 40% of both males and females had been tattooed. However, injection drug use risk behaviors were rare.
Race/Ethnicity
Among males, significantly more African Americans than non-Hispanic Whites engaged in certain sexual risk behaviors. However, many drug risk behaviors, including ever using drugs other than marijuana and recent use of drugs other than marijuana, were more prevalent among non-Hispanic Whites and Hispanics than among African Americans.
Among females, significantly more nonHispanic Whites than African Americans or Hispanics engaged in several of the sexual risk behaviors. As among males, drug risk behaviors, including ever using drugs other than marijuana and recent use of drugs other than marijuana, were more prevalent among non-Hispanic Whites and Hispanics than among African Americans.
Some drug risk behaviors were more prevalent among non-Hispanic White and Hispanic females than among African Americans.
Age
Our choice of categories was guided by empirical analyses.39 Among males, even in the youngest age group (10–13 years), 62% to 76% had vaginal sex, used alcohol, or used marijuana. Many behaviors were higher in the 14-to-15 and the 16 years and older age groups than in the 10- to 13-year-old group. However, few significant differences were found between the 2 older age groups.
Among females aged 10 to 13, more than half were sexually active, more than 40% had vaginal sex, more than 80% used alcohol, and more than two thirds used marijuana. Many risk behaviors were more prevalent among older females. Almost 95% of the females aged 16 and older were sexually active, more than half had recent unprotected vaginal sex, more than 90% used alcohol or marijuana, and more than half had been tattooed.
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DISCUSSION |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Our findings confirmed that HIV and AIDS risk behaviors are a substantial problem among detained youths, posing a challenge to the justice system and to the larger public health system.5,6,25–31,40–44 The rates found in our study are much higher than those in the general population45 and confirm prior findings of racial/ethnic differences.45–47 Ninety-five percent of our sample engaged in 3 or more risk behaviors reported in this brief; 65% reported 10 or more risk behaviors.
Subjects may have exaggerated their behaviors or underreported them. Moreover, this study used only 1 site and pertains to only urban youths. Nevertheless, our data have important implications for research and public health policy.
Directions for Future Research
Research is needed to examine how psychosocial factors common among delinquent youths—sexual abuse, poor family functioning, mental disorders, lifetime trauma, and cognitive and functional impairment48—affect the development of HIV and AIDS risk behaviors. Information is especially needed on structural factors that are commonly associated with delinquency among youths: poverty, poor education, and neighborhood disintegration.49–52 Longitudinal studies would provide data on onset, persistence, desistance, and recurrence of HIV and AIDS risk behaviors and whether specific patterns of risk predict seroconversion.
Implications for Public Health Policy
The public health system must
- Provide interventions for detained youths. Because many detainees are truant,53 they may miss school-based interventions. Interventions could improve HIV and AIDS knowledge, attitudes, and behavioral skills.27,30,54 Intervening with detained youths could reduce the likelihood of the onset of the most risky HIV and AIDS risk behaviors—having unprotected anal sex, using or sharing needles, and trading drugs for sex—that are still relatively rare.
• Intervene early. The youngest age group (10–13 years) had lower rates of the most risky behaviors (e.g., multiple sexual partners, vaginal sex with high-risk partners, and unprotected sex while drunk or high). Interventions with younger adolescents could avert the most serious risk behaviors.
- Target specific patterns of risk based on gender, race/ethnicity, and age. For example, female detainees, although relatively few in number, require special programs. Sexual risk behaviors may place females at greater risk than males because they are more likely to contract HIV from unprotected vaginal sex.55–57 Moreover, females’ behaviors place their unborn children at risk.
Providing HIV and AIDS interventions to juvenile detainees could reduce HIV and AIDS among general population youths. Most detainees return to their communities within 2 weeks.3 Moreover, many youths at particular risk for HIV and AIDS—youths who use drugs, youths who trade sex for money or drugs, and runaways—will eventually cycle through the detention center. HIV and AIDS risk behaviors among juvenile detainees are a public health problem, not just a problem for the juvenile justice system.
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Acknowledgments |
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This work was supported by National Institute of Mental Health grants R01MH54197 and R01MH59463 (Division of Services and Intervention Research and Center for Mental Health Research on AIDS) and grant 1999-JE-FX-1001 from the Office of Juvenile Justice and Delinquency Prevention. Major funding also was provided by the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration (Center for Mental Health Services, Center for Substance Abuse Prevention, Center for Substance Abuse Treatment), the Centers for Disease Control and Prevention (National Center on Injury Prevention and Control and National Center for HIV, STD and TB Prevention), the National Institute on Alcohol Abuse and Alcoholism, the National Institutes of Health (NIH) Office of Research on Women’s Health, the NIH Center on Minority Health and Health Disparities, the NIH Office on Rare Diseases, 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. We thank all our agencies for their collaborative spirit and steadfast support.
Many more people than the authors contributed to this project. This study could not have been accomplished without the advice of Ann Hohmann, PhD, Kimberly Hoagwood, PhD, and Heather Ringeisen, PhD. Jacques Normand, PhD, Helen Cesari, MS, Richard Needle, PhD, Robert Booth, PhD, David Huizinga, PhD, and David Ostrow, MD, PhD, generously offered their expertise in developing our instruments. David Stoff, PhD, Grayson Norquist, MD, and Delores Parron, PhD, provided support and encouragement. Celia Fisher, PhD, guided our human subjects’ procedures.
We thank all project staff, especially Amy Lansing, PhD, for supervising the data collection. We also thank Laura Coats, our expert editor and research assistant, and Kate Elkington for her meticulous library work. We also greatly appreciate the cooperation of everyone working in the Cook County systems, especially David Lux, our project liaison. Without Cook County’s cooperation, this study would not have been possible. Finally, we thank the participants for their time and willingness to participate.
Human Participant Protection
This research was approved by the Northwestern University and Centers for Disease Control and Prevention institutional review boards. We obtained informed consent from all participants aged 18 and older. For participants younger than 18, we obtained assent from the youths and consent from a parent or guardian, whenever possible; when this was not possible, youth assent was overseen by a participant advocate representing the interests of the youth.
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Footnotes |
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Contributors
L. A. Teplin, the principal investigator, planned the study, directed the project, and crafted the presentation. A. A. Mericle developed the HIV and AIDS risk assessment, supervised interviewer training and data preparation, conducted much of the data analysis, and drafted some sections of the brief. G. M. McClelland directed the data operation and data analysis and oversaw preparation of the tables. K. M. Abram directed the field study. All authors participated in the preparation of the final manuscript.
Accepted for publication November 25, 2002.
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