Tapping the “Town and Gown” Potential for Correctional Health Research Collaborations

Background: Collaborations between juvenile justice systems (town) and academia (gown) promise to significantly enhance what we understand about high rates of sexually transmitted infections (STIs) found among detained populations, particularly African American young women. However, research related to the sexual health of adolescent detainees has not occurred in proportion to the magnitude of issues found in the population. While there are many challenges to conducting research with this population, there are also lessons learned and best practices from other studies that may provide guidance. Methods: In 2015, we implemented a pilot project with young women in a detention center to understand the association between STIs and relationship dynamics. Using a formative assessment-based approach, the team periodically compared expectations to actual milestones and outcomes. This approach has provided feedback, guidance and lessons learned that we will use to adjust our pilot project. Results: Three challenges emerged from our review: concerns related to different agendas, bureaucratic difficulties and human protection. In addressing these challenges, we identified study procedures to revise and to incorporate into future works. Conclusions: Juvenile justice and academic partnerships require extensive pre-research work to account for the many challenges to implementing and conducting projects with this population. However, “town and gown” approaches to understanding and improving the sexual health of detainees can result in a more complete assessment of these issues compared to either a solely academic or juvenile justice investigation

Associations among Substance Use, Mental Health Disorders, and Self-Harm in a Prison Population: Examining Group Risk for Suicide Attempt

Substance use disorders (SUD) and mental health disorders are significant public health issues that co-occur and are associated with high risk for suicide attempts. SUD and mental health disorders are more prevalent among offenders (i.e., prisoners or inmates) than the non-imprisoned population, raising concerns about the risk of self-harm. This cross-sectional study examined the population of a state prison system (10,988 out of 13,079) to identify associations among SUD (alcohol, cannabis, intravenous drugs, narcotics, and tobacco smoking), mental health disorders (anxiety, bipolar, depression, and psychotic disorders), and suicide attempts. The primary aim was to determine which groups (SUD, mental health disorders, and co-occurrences) were strongly association with suicide attempts. Groups with a documented SUD or mental health disorders compared to peers without these issues had 2.0 and 9.2 greater odds, respectively, for attempting suicide, which was significant at p < 0.0001 for both conditions. There were also significant differences within SUD and mental health disorders groups in regard to suicide attempts. Groups with the greatest odds for suicide attempts were offenders with comorbid bipolar comorbid and anxiety, alcohol combined with depression, and cannabis co-occurring with depression. Documentation of suicide attempts during imprisonment indicates awareness, but also suggest a need to continue enhancing screening and evaluating environmental settings

A call to develop evidence-based interventions to reduce sexually transmitted infections in juvenile justice populations

© Meharry Medical College. Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) risk, are a significant health issue for young women (ages 16-21), especially African Americans with a juvenile justice history. Studies have found that 44% of young African American women have had at least one STI compared to 24.1% for all young women. The rate of STIs among young women with juvenile justice histories, particularly African Americans, is likely much higher than their non-detained peers. Yet, there are few evidence-based interventions (EBIs) designed specifically for the detained population. In 2014, the Centers for Disease Control and Prevention’s Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention listed few programs that comprehensively included components related to mental health, intimate relationships and high risk sexual behaviors that would be salient for a detained population. Further, many EBIs have had limited or no long-term protective effect. We propose that interrelated factors (mental health, substance use, trauma and intimate relationships) can effectively decrease risk and increase protective behaviors for the detained population most at risk