Drug Abuse, Incarceration and Health Disparities in Hiv/Aids: A Longitudinal Study of Juvenile Justice Youth Northwestern University Feinberg School of Medicine Linda A. Teplin, Ph.D., Principal Investigator (312) 503-3500, Lemail@example.com The overall goal of this project is to address how disproportionate confinement of racial/ethnic minorities — especially African Americans — affects health disparities in the HIV/AIDS epidemic. African Americans comprise only 13% of the general population, but about 40% of incarcerated youth and adults, and 50% of new cases of HIV/AIDS. Yet, large multisite national longitudinal studies of HIV/AIDS focus on high-risk samples such as men who have sex with men (MACS), women infected with HIV and other “at- risk” females (WIHS), and infected women and their infants (WITS). These studies do not include adolescents, do not sample correctional populations, and do not examine how incarceration affects HIV/AIDS. Most studies of incarcerated populations are cross- sectional and provide limited information on the effects of incarceration. FACT SHEET 1. What are our Specific Aims? Aim 1: Describe patterns of drug use and disorder as juvenile justice youth age from adolescence to emerging adulthood and young adulthood. We will focus on racial/ethnic disparities, gender and age differences, and risk and protective factors. Of key importance is how incarceration, release, and re-entry (e.g., age[s] incarcerated; number of incarcerations; length of incarcerations; amount of time spent in the community between incarcerations; terms of release) affect drug use behaviors and drug use disorders. Aim 2: Describe patterns of HIV/AIDS risk behaviors as juvenile justice youth age from adolescence to emerging adulthood and young adulthood. As in Aim 1, we will study onset, persistence, desistance, and recurrence, focusing on racial/ethnic disparities, gender and age differences, and risk and protective factors. Of key importance is how incarceration, release and re-entry affect HIV/AIDS sex risk behaviors and injfection risk behaviors. Aim 3: Describe the prevalence and incidence of HIV infection and other STIs, focusing especially on gender differences and racial/ethnic disparities: Aim 4: Examine the relationship between drug use and disorder and HIV/AIDS risk behaviors. We will focus on gender differences, racial/ethnic disparities, and on how incarceration, release, and re-entry affect this relationship. 2. How is the sample unique? Our sample (n=1829 participants) was recruited when they were aged 10-18 years. The sample has the following advantages: Size: Large enough to investigate uncommon combinations of drugs, comorbid mental disorders, and uncommon HIV/AIDS risk behaviors; Racial/ethnic diversity: Enough African Americans and Hispanics (and diversity within Hispanics) to respond to NIH’s program objectives on health disparities; A large subsample of females: Females, who comprise X% of our sample, increasingly suffer from HIV/AIDS and are involved in the justice systems; 3. How is the Northwestern Juvenile Project relevant for to the nation’s public health? Disproportionate confinement of racial/ethnic minorities, especially African Americans, may be one source of health disparities in the HIV/AIDS epidemic. The Northwestern Juvenile Project provides a unique opportunity to examine how incarceration affects health disparities in drug abuse and HIV/AIDS in an exceptionally high-risk group that is seldom investigated – juvenile detainees. 4. Has this population been investigated in other large-scale studies? Large multisite national longitudinal studies of HIV/AIDS focus on high-risk samples such as men who have sex with men (MACS), women infected with HIV and other “at-risk” females (WIHS), and infected women and their infants (the Women and Infants Transmission Study [WITS]). These studies do not include adolescents, do not sample correctional populations, and do not examine the effect of incarceration on HIV/AIDS. 5. Have other studies examined how incarceration affects HIV/AIDS risk and infection? Surveys of middle and high school adolescents, the National Longitudinal Survey of Adolescent Health and the Youth Risk Behavior Surveillance Study, collect some data on drug use and sexual behaviors. These studies, however, do not extend beyond adolescence. Moreover, youth at the greatest risk of contracting HIV — such as juvenile justice youth — are underrepresented in these samples because delinquent youth are often truant or are not sampled while detained. Studies of correctional populations provide limited information on the effects of incarceration on HIV/AIDS. Most are cross-sectional and the few longitudinal studies had follow-up periods of 1 year or less. 6. HOW IS THE DESIGN UNIQUE? We already have extensive baseline data, including psychiatric diagnoses, patterns of substance use, criminal history, and HIV/AIDS risk behaviors). Our longitudinal design has several important features: Prospective longitudinal data: The project will generate data on key developmental periods: adolescence (10-18), emerging adulthood (18- 24), and young adulthood (25+). Follow-up interviews with all participants, whether the subject is in the community or incarcerated. Sufficient variation in incarceration “careers.” Our sample includes participants with a variety of correctional experiences: detained only, detained and jailed but never imprisoned, imprisoned but released, and imprisoned for long periods of time. Data on HIV/AIDS risk behaviors since the baseline interview, when participants were aged 10-18 years. Access to official records (per court order). 7. HOW DOES THE NORTHWESTERN JUVENILE PROJECT ASSESS HIV/AIDS RISK? Our data on HIV/AIDS risk behaviors are comparable in detail to those collected in the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS). They drew from those used in the MACS and WIHS. 8. WILL WE BE ABLE TO FIND OUR PARTICIPANTS SO THAT WE CAN REINTERVIEW THEM? Since April 1996, we have been tracking our participants using a variety of state-of-the-art locating tools (mail, phone, internet searches, institutional records and field visits), managed with a sophisticated computerized recordkeeping system (Oracle). Participation rates are between 84.0% and 97.5% 9. HOW CAN THE FINDNGS GUIDE PUBLIC POLICY? Although the United States has the highest incarceration rate in the world, surprisingly few studies examine the effects of incarceration. The proposed study will provide information needed to improve public health in the following ways: Reduce health disparities for HIV/AIDS. The study will examine how disproportionate confinement of African Americans affects disparities in the HIV/AIDS epidemic. Reduce HIV/AIDS in young persons, especially among persons who have been incarcerated. Data will help identify premorbid risk and protective factors that are potentially malleable, as well as optimal points of intervention. Plan gender-specific interventions, especially for African American women. HIV/AIDS is now a growing and persistent health threat to women in the United States, especially young women and women of color. Improve HIV interventions for persons with comorbid substance use and mental disorders. This study will demonstrate how comorbid disorders influence patterns of HIV/AIDS risk behaviors in the community and in correctional facilities. Contribute to the development of theoretical models of drug abuse and HIV/AIDS risk. The proposed study will extend current conceptual models to include important variables that are seldom investigated: incarceration, release, and reentry. 10.WHO IS CO-FUNDING THE PROJECT? The Northwestern Juvenile Project has been funded by the National Institute on Drug Abuse (NIDA), Office of Juvenile Justice and Delinquency Prevention (OJJDP), National Institute of Mental Health (NIMH), National Institute on Alcohol Abuse and Alcoholism (NIAAA), Centers for Disease Control and Prevention (CDC), Center for Substance Abuse Prevention (CSAP), Center for Mental Health Services (CMHS), Center for Substance Abuse Treatment (CSAT), NIH Center on Minority Health and Health Disparities (NCMHD), NIH Office of Research on Women’s Health (ORWH), NIH Office of Rare Diseases, Department of Labor, Department of Housing and Urban Development, Robert Wood Johnson Foundation, and the William T. Grant Foundation. 11. HOW WILL FINDINGS BE DISSEMINATED TO MAXIMIZE THE POTENTIAL BENEFIT OF THIS STUDY? The Northwestern Juvenile Project has been cited in the Surgeon General’s report on children’s mental health and is used by national advocacy groups and in reports to Congress. Our studies of adults have been cited in Supreme Court amicus briefs, in congressional hearings, in 3 recent reports of the Surgeon General, and by many federal agencies, private agencies, and advocacy groups. We publish articles in journals that are widely read and broadly distributed. We also collaborate with organizations such as the American Bar Association (Commission on Youth at Risk), National Alliance of the Mentally Ill, the National Mental Health Association, the National Institute of Corrections, and the National Juvenile Detention Association to ensure that our data are disseminated to those who work in the field and who make policy decisions. We are committed to making sure our data are used to improve the public health of the nation by reducing drug abuse and HIV/AIDS.
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