Drug Abuse, Incarceration and Health Disparities in Hiv/Aids: by jcgx0jT

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									                      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, L-teplin@northwestern.edu


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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