Prevention at Point of Initial Court Contact: Health Risk Behaviors Among First-Time Offending Youth Diverted from Incarceration

Introduction: A juvenile’s first point of contact with the juvenile court system represents an opportune moment for assessment and intervention.  Of all offending adolescents, 80% are never detained or incarcerated thereby automatically limiting their access to medical and behavioral health services that are more readily available in confined settings.   Several cross-sectional studies have identified that court-involved, but non-incarcerated (CINI) juveniles exhibit significant substance use and HIV/STI risk behavior rates and that substance use, psychiatric symptoms and HIV/STI risk behaviors commonly co-occur in juvenile offending populations. Yet, among CINI juveniles committing first-time offenses, there is a gap in our knowledge about what other risk behaviors are already occurring at point of first legal contact so that we may tailor the development of relevant integrated public health interventions early and while they are in the community. Learning more about drug use and associated risk behavioral patterns among CINI juvenile offenders has profound public health implications in terms of promoting health equity in this young, vulnerable population. 

Methods: Data are from an ongoing longitudinal epidemiological assessment study investigating 24-month trajectories of drug use, HIV/STI risk behavior, psychiatric symptoms, and recidivism among 400 first-time offending, CINI juvenile offenders (200 status and 200 delinquent) and an involved caregiver. Juveniles completed risk behavior measures in their home/community using tablet-based ACASI.  Baseline data on juvenile lifetime and recent substance use (alcohol, marijuana and other drug use) and lifetime and recent HIV/STI risk behaviors are presented; by legal type (first-time status versus delinquent offending) and gender (male/female).

Results:   Rates of lifetime alcohol, marijuana and other drug use were up to 36% for alcohol, up to 53% for marijuana and up to 13% for other drug use; first-time delinquent youth endorsed higher rates of lifetime use of all substances.  Among those with lifetime use, rates of recent (past 4 months) use ranged up to 84% for alcohol and up to 76% for marijuana use with first time status offending youth endorsing greater rates of more recent use than delinquent offenders.  In terms of sexual activity, 42% of the sample reported lifetime sexual activity with 43% of status and 80% of delinquent offenders reporting recent sexual intercourse.  Seventy-three percent and 63% of sexually active status and delinquent offenders, respectively, reported condom use at last sex. Gender comparisons suggest that rates of substance use and HIV/STI risk behaviors are highest among delinquent offending girls.

Conclusions:   High rates of substance use and HIV/STI risk behaviors suggest need for early public health intervention among CINI youth to improve health outcomes.  Preliminary analyses suggest that gender-responsive screening and intervention may be critical.  Public health and juvenile justice systems must identify ways to partner at this stage of early juvenile justice involvement to promote health equity for CINI youth in the community and to provide screening and intervention at the earliest stage of the offending trajectory.