Linda A. Teplin - US grants

This project is a "competing" application for "Mental Disorder in an Urban Jail" (MH37988) which was funded for 3 years. The goal of MH37988 was to provide data relevant to the criminalization hypothesis, i.e., the speculation that mentally ill persons who might heretofore have been treated with in the mental health system are increasingly managed by the criminal justice process. Criminalization is though to be a consequence of modifications in mental policies, i.e., deinstitutionalization, more stringent commitment criteria, and reductions in treatment programs for the mentally ill. MH37988 had two goals: (1) Prevalence--to ascertain the prevalence rates of mental disorder among 728 randomly-selected male detainees in one typical urban county jail. Of particular importance was to determine if the rates of severe mental disorder (psychosis) were significantly different form baseline population data as ascertained from the Epidemiological Catchment Area (ECA) Project. (2) Detection and Treatment--to explore the extent to which detainees exhibiting signs of serious mental disorder are detected and given psychiatric treatment while being processed through the criminal justice system. While MH37988 provides crucial information concerning the prevalence and treatment of male mentally disordered offenders, the epidemiology and criminology literature indicates that we cannot generalize these findings to females. This proposal sets forth a plan to replicate using a female sample. Although there have been several investigations of mental disorder among samples, prior research has suffered from 4 methodological limitations: (1) insufficient sample size to reliably detect rare events such as severe mental disorder, (2) non-random samples, e.g., treatment samples, (3) imprecise measurement of mental disorder, and (4) lack of baseline comparisons. The lack of reliable data on female offenders is particularly unfortunate because both the volume of female criminal activity and the sheer number of incarcerated females are at am a;;-time high and are increasing at a substantially higher rate than among males. The proposed study will move beyond the extant research by incorporating the following characteristics: (1) a random sampling strategy, (2) a sufficiently large N (750), (3) a reliable method of diagnosis (the NIMH-DIS), and (4) baseline comparisons with the NIMH Epidemiological Catchment Area (ECA) project. This research will aid in planning public policy modifications and health delivery strategies within the mental health and criminal justice systems, as well as suggest viable alternatives to incarceration for mentally disordered female offenders.

To date, few studies have examined the relationship between citizens' alcohol use and police response, preferring to examine the link between alcohol and crime by studying arrest records, suspects-awaiting trial, convicted felons, or detox-treatment residents. Although these studies provide valuable knowledge concerning alcohol use among such people, the findings may or may not be applicable to persons who are removed from the potential sample because their case is diverted at some point prior to arrest convictin, or the application of the "alcoholic" label. The proposed study will attempt to move beyond the previous research literature by examing data from an earlier point in the ciminal justice system. Two research questions will be examined: (1) the extent to which citizens' alcohol use is related to breaches-of-the-peace and/or other "criminal" activity which results in the presence of police; and (2) whether or not he use of alcohol on the part of the suspect(s)/complainant(s)/victim(s)/ witness(es) determines the police officer's disposition of the situation. The methodology involves two components: (1) trained observers will accompany police on their regular patrol activities. An observational instrument has been developed and pilot-tested which will code the type and nature of police-citizen encounters and an "alcohol-use checklist" has been devised to assess the extent of alcohol involvement among the suspect(s)/witness(es)/victim(s)/complainant(s); (2) police reports, when written, will be examined, with emphasis on the ways in which alcohol use is recorded in the report. Since the data will be collected at the initial point in the criminal justice system, the research will examine a sample heretofor largely unstudied. Moreover, by examining the role of citizens' alcohol use on the officer's definition & dispositon of the situation, the research will provide some insight as to the extent to which alcohol use on the part of citizens may influence the processin of the case. Potentially, this information may be used to infer, albeit in a limited way, whether or not previous research may have over- or underestimated the relationship between alcohol and "criminal activity."

This proposal outlines a plan for continuing the work conducted under grant #AA05884 for an additional two year period. Funding is requested for two purposes: (1) 6 months of support to complete the initial goals of #AA05884. This study had two specific aims: first, to assess the role of alcohol use in criminal activity, and second, to examine the effect of citizen's drinking on the police officer's arrest decision. (2) 18 months of funding is requested to pursue a serendipitous finding of #AA05884, specifically, the effect of concomitant psychopathology on the alcohol-crime relationship. The qualitative data from #AA05884 indicate that the psychiatric status of the suspect has potentially important bearing on the relationship between drinking and crime. The related literature also confirms the potential importance of concomitant psychopathology in understanding the alcohol-crime relationship. Since #AA05884 did not include variables pertaining to the psychiatric status of the observed citizens, this issue cannot be investigated using the #AA05884 data. However, another data set collected under grant #MH37988 is available for this purpose. The aims of this new component are twofold: (a) The Prevalence of Alcohol Abuse Disorders, Co-occurring Psychopathology, and State of Intoxication at Time of the Crime. Although a number of studies have documented the prevalence of psychopathology and alcohol abuse patterns among jail detainees, there has not been any investigation of the co-prevalence of these disorders. This is a significant omission because data on psychiatric populations demonstrate a very high co-occurrence of alcohol use and psychopathology. Since both the type of psychopathology and its chronology of onset vis-a-vis alcoholism are known to impact on the course of alcoholism and the efficacy of alcohol abuse treatment, information on the psychiatric profiles of alcoholic detainees will be highly relevant to programmatic considerations concerning alcoholism intervention strategies. (b) Alcohol use and Psychopathology as Predictors of Criminal Activity. There is evidence among psychiatric samples that diagnostic profiles differentiate criminal patterns among alcoholics. More important, some research has shown that the efficacy of treatment in reducing criminal activity among alcoholics is dependent in part upon the presence and type of co- occurring disorders. Thus, the role of co-occurring psychopathology in determining criminal patterns would provide important information bearing on the nature of the alcohol-crime relationship and assist in making probabilistic assessments of criminal recidivism when making parole and probationary decisions for alcoholic detainees.

The proposed study will augment another NIMH project, "Mental Disorder in an Urban Jail" (MH45583), which was approved for three years and is scheduled to begin Summer, 1990. MH45583 will investigate the prevalence and detection/treatment of mentally-disordered female jail detainees. MH45583 examines only singular disorders; it will not investigate multiple disorders. To date, no study of female jail detainees has examined comorbidity. This omission is critical because both the volume of female criminal activity and the-number of incarcerated females are increasing at a substantially faster rate than among males. Female crime rates are at an all time high. We have enlarged MH45583 to enable us to examine the same two questions -- prevalence and detection/treatment -- in relation to multiple alcohol/drug/mental (ADM) disorders. Our specific aims are: (1) to ascertain the prevalence of multiple ADM disorders in female jail detainees (N - 1200). As in MH45583, we will contrast the jail rates with the Epidemiologic Catchment Area (ECA) data. We will also describe the sample's level of functioning prior to arrest; our goal is to compare the relative disability of persons with singular disorders to those with multiple ADM disorders, and to determine which diagnostic profiles have particularly low levels of functioning. (2) To determine the extent to which persons with multiple ADM disorders are detected and treated while in jail. Of particular interest is if persons with multiple ADM disorders are more or less likely to be treated than those with singular disorders. The proposed study has four methodological advantages over prior work: (1) a random sample; (2 a large enough N (1200) to generate reliable rates of comorbidity; (3) a reliable instrument (the NIMH Diagnostic Interview Schedule); and (4) baseline comparisons with the NIMH ECA Project. The prevalence data will help us put the system's scarce resources to their best use. Psychiatric treatment of mentally ill jail detainees is mandated by law. Treating persons with multiple ADM disorders, however, is complicated. They require different treatments and are more resistent to treatment than those with singular disorders. Accurate prevalence rates of comorbidity will point to appropriate rehabilitation strategies designed to treat the most common diagnostic profiles. The detection and treatment information will document how persons with dual diagnoses are managed while in the custody of the criminal justice system. Before making public policy changes, we need to know how persons with dual diagnoses are currently treated. These data will aid in planning modifications in health delivery strategies within the mental health and criminal justice systems, as well as suggest viable alternatives to incarceration for female detainees who are mentally ill and also have a substance abuse disorder.

This study has two goals: (1) Prevalence. To ascertain the prevalence rates of severe mental disorder among 750 randomly selected female jail detainee in Cook County Department of Corrections (CCDC) in chicago, Illinois. We will determine if the rates of severe mental disorder are significantly different than baseline population rates ascertained by the Epidemiologic Catchment Area (ECA) Project; (2) Detection and Treatment. To explore the extent that mentally ill female jail detainee are detected and treated while in jail. We will determine at which point in the process the detainee is treated and which variables, such as violent behavior or suicidal ideation, determine referral and treatment decisions. Prior studies of mental disorder among female offender samples suffer from four methodological limitations. First, few studies use random samples. Second, samples were too small to generate reliable rates of serious mental disorders. Third, many studies used unspecified diagnostic criteria and/or nonstandardized instruments to assess mental disorder. Finally, because no study has systematically compared its findings to baseline (population) rates, we cannot know if the observed rates of mental disorder are greater than would be expected by chance. This study has four methodological advantages over prior epidemiologic work: (1) a random sampling strategy; (2) a sufficiently large N (750) to generate reliable prevalence rates; (3) a reliable method of diagnosis (the NIMH Diagnostic Interview Schedule); and (4) baseline comparisons with the general population (ECA). Reliable data on female offenders is critical because both the volume of female crime particularly violent crime, and the number of incarcerated females are increasing at a faster rate than among males. The prevalence data will help us put the system's scarce resources to their best use. Psychiatric treatment of mentally ill jail detainee is mandated by law. Without accurate prevalence rates, however, we cannot know how best to use the criminal justice system's scarce resources. Accurate prevalence rates will point to appropriate rehabilitation strategies designed to treat the most common diagnostic profiles. The detection and treatment information will document how mentally ill female jail detainee are managed while in the custody of the criminal justice system. Before making public policy changes, we need to know how mentally ill jail detainee are currently treated. These data will aid in planning health delivery strategies within the mental health and criminal justice systems, as well as suggest viable alternatives to incarceration for mentally ill female jail detainee.

We propose adding a longitudinal component to our current NIMH-funded study of juvenile detainees (MH54197) to complement the NIMH-funded study, "Use, Need, Outcomes and Costs in Children and Adolescent Population" (UNOCCAP), of general population youth. Although researchers speculate that many juvenile detainees have alcohol, drug or mental (ADM) disorders, there are few empirical data. Our current study is the first large-scale study of alcohol, drug and mental health (ADM) service needs of juvenile detainees (n=1800 detainees; 1200 males and 600 females, 10-17 years old). Our current study does not include follow-up interviews and no general population comparisons. Because we collect extensive baseline data and (funded by grants from NIMH, NIDA the MacArthur Foundation), we are tracking them, we have a unique opportunity. By adding a longitudinal component, we could investigate the incidence and course of ADM disorders during a key developmental period as well as whether or not their disorders are detected, the time of services they receive, and their level of unmet meed. Adding a longitudinal component to our current study would also allow us to study prospectively three risky behaviors- drug use, violence and HIV risk behaviors- all of which are major public health problems and are prevalent among delinquent youth. The proposed study has three specific aims: (1) ADM Service Needs. We will re-assess the extent and distribution of ADM disorders (including incidence, duration, patterns, sequence of co-morbidity and risk and protective factors) and functional impairments among our subjects and compare them to general population (UNOCCAP) rates. (2) Service Utilization. We will assess whether or not juveniles who need services (as determined in Specific Aim #1) receive them after their cases reach disposition (whether they are in the community or incarcerated), from which system (e.g., mental health, juvenile or adult justice, child welfare, etc.), which services they receive, and how patterns of use differ from those of general population youth. (2) Risky Behaviors. We will assess the patterns and developmental sequence of drug use, violence, and HIV risk behaviors in our sample, including the antecedents of these risky behaviors (especially ADM disorders), how youth developed these risky behaviors and how these behaviors are interrelated. This proposal responds to the NIMH National Plan for Research on Child and Adolescent Mental Disorders, which called for research on mental health services among juvenile offenders; to Healthy People 2000, which called for research on reducing HIV risk behaviors; to NIDA's Program Announcements PA-95-022, PA-95-057, PA-95-059, PA-955-055, and PA-95-083; and to NIDA's March, 1996 amendment requesting research on the co- occurrence, developmental sequence, and health consequences of violence, drug abuse and HIV/AIDS.

The proposed study will augment another NIMH project, "Mental Disorder in an Urban Jail" (MH45583), which was approved for three years and is scheduled to begin Summer, 1990. MH45583 will investigate the prevalence and detection/treatment of mentally-disordered female jail detainees. MH45583 examines only singular disorders; it will not investigate multiple disorders. To date, no study of female jail detainees has examined comorbidity. This omission is critical because both the volume of female criminal activity and the-number of incarcerated females are increasing at a substantially faster rate than among males. Female crime rates are at an all time high. We have enlarged MH45583 to enable us to examine the same two questions -- prevalence and detection/treatment -- in relation to multiple alcohol/drug/mental (ADM) disorders. Our specific aims are: (1) to ascertain the prevalence of multiple ADM disorders in female jail detainees (N - 1200). As in MH45583, we will contrast the jail rates with the Epidemiologic Catchment Area (ECA) data. We will also describe the sample's level of functioning prior to arrest; our goal is to compare the relative disability of persons with singular disorders to those with multiple ADM disorders, and to determine which diagnostic profiles have particularly low levels of functioning. (2) To determine the extent to which persons with multiple ADM disorders are detected and treated while in jail. Of particular interest is if persons with multiple ADM disorders are more or less likely to be treated than those with singular disorders. The proposed study has four methodological advantages over prior work: (1) a random sample; (2 a large enough N (1200) to generate reliable rates of comorbidity; (3) a reliable instrument (the NIMH Diagnostic Interview Schedule); and (4) baseline comparisons with the NIMH ECA Project. The prevalence data will help us put the system's scarce resources to their best use. Psychiatric treatment of mentally ill jail detainees is mandated by law. Treating persons with multiple ADM disorders, however, is complicated. They require different treatments and are more resistent to treatment than those with singular disorders. Accurate prevalence rates of comorbidity will point to appropriate rehabilitation strategies designed to treat the most common diagnostic profiles. The detection and treatment information will document how persons with dual diagnoses are managed while in the custody of the criminal justice system. Before making public policy changes, we need to know how persons with dual diagnoses are currently treated. These data will aid in planning modifications in health delivery strategies within the mental health and criminal justice systems, as well as suggest viable alternatives to incarceration for female detainees who are mentally ill and also have a substance abuse disorder.

DESCRIPTION (provided by applicant): We propose to extend the Northwestern Juvenile Project to examine the developmental patterns of drug use and disorder and risk for HIV/AIDS and other sexually transmitted infections (STIs) as juvenile justice youth age from adolescence to emerging adulthood and young adulthood. This study responds to NIDA's new initiatives in health disparities in HIV/AIDS in minority populations, specifically the nexus of drug abuse, criminal justice involvement, and HIV/AIDS among African Americans. African Americans comprise 12% of the US population but 40% of incarcerated populations and 50% of new cases of HIV/AIDS. At year-end 2004, nearly 100,000 juveniles and nearly 2.1 million adults were incarcerated. We will continue to study a racially/ethnically diverse sample (n=758;330 females, 428 males;412 African Americans, 137 non-Hispanic whites, 207 Hispanics, 2 other race/ethnicity) of persons who were arrested and detained in Cook County (Chicago) Illinois, aged 10-18 years at recruitment (1997-1998). Since recruitment, data have been collected on the development of substance use and disorders, risk and protective factors, and HIV/AIDS risk behaviors. Participants are re-interviewed whether they are (re)incarcerated or back in the community. We propose to conduct annual interviews 10, 11, 12, and 13 years post-baseline, collect records, and test for HIV infection and selected STIs. Focusing on racial/ethnic disparities, gender and age differences, and effects of incarceration, we will: (1) describe patterns of drug use and disorder - onset, persistence, desistence, and recurrence -- as juvenile justice youth age from adolescence to emerging adulthood and young adulthood;(2) describe patterns of HIV/AIDS risk behaviors during this same period;(3) describe the prevalence and incidence of HIV infection and other STIs;and (4) examine the relationship between drug use and disorder and HIV/AIDS risk behaviors. Extending the Northwestern Juvenile Project allows us to leverage the data already collected to examine health disparities and the role of disproportionate minority confinement in the development of drug use and disorder and HIV/AIDS risk;to identify risk and protective factors that are potentially malleable;to identify points of intervention at key developmental periods;and to extend theoretical models - developed in general population adolescents - to correctional populations.

[unreadable] DESCRIPTION (provided by applicant): We propose to extend the Northwestern Juvenile Project to examine the dynamic relationships among patterns of drug use and disorder, risk and protective factors for drug use and disorder, and adult social role performance as juvenile justice youth age from adolescence to emerging adulthood and young adulthood. This study responds to NIDA's new initiatives on drug abuse, health disparities, and disproportionate minority confinement of African Americans. At year-end 2004, nearly 100,000 juveniles and nearly 2.1 million adults were incarcerated. African Americans comprise 12% of the US population but 40% of incarcerated populations. We are studying a racially/ethnically diverse sample (n=1709; 624 females, 1085 males) in Cook County (Chicago) Illinois, aged 10-18 years at recruitment (1995-1998). Youth are reinterviewed whether they are (re)incarcerated or back in the community. Our goal is to focus on gender differences, racial/ethnic disparities, and the effect of incarceration as we: (1) describe patterns of drug use and disorder --onset, persistence, desistence, and recurrence - as juvenile justice youth age from adolescence to emerging and young adulthood; (2) examine how risk and protective factors (e.g., comorbid mental disorders, adverse life events, availability of illicit drugs) predict, moderate, and mediate patterns of drug use and disorders; and (3) examine the dynamic relationships between patterns of drug use and disorder and adult social role performance (e.g., residential independence [including avoiding incarceration], employment, marriage, parenting, desistance from crime and violence). To analyze the longitudinal data, we will use summary statistics (e.g., prevalence rates, odds ratios), generalized linear mixed-effects models, survival analyses, and Muthen's recently developed extensions of growth mixture models. Extending the Northwestern Juvenile Project allows us to leverage the data already collected to examine the role of incarceration in the development of drug use and disorder, especially among African Americans; to identify risk and protective factors that are potentially malleable; to identify points of intervention at key developmental periods; and to extend theoretical models - developed in general population adolescents -- to correctional populations. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): 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 the effect of incarceration on HIV/AIDS. Most studies of incarcerated populations are cross-sectional and provide limited information on the effects of incarceration. To continue to address this key omission in the literature, we propose to extend the Northwestern Juvenile Project, a longitudinal study of 1829 juvenile justice youth, enrolled at age 10-18 years (1172 males, 657 females;1005 African Americans, 296 non-Hispanic whites, 524 Hispanics, and 4 "other" race/ethnicity). Currently, the HIV/AIDS component of the project (RO1 DA022953) includes only a subsample (n=743) and 10-, 11-, 12-, and 13-year follow-up interviews. We now propose to (1) study the entire sample (originally 1829, now 1678);(2) conduct 3 additional annual interviews (14-, 15-, and 16-year follow-ups), at which time participants will be aged 26-34 years;(3) collect official records to cross-validate self-reported data (on STI status, arrests, incarceration history, and services received);(4) test the entire sample for HIV infection, chlamydia, and gonorrhea;and (5) administer a new module on incarceration, release, and re-entry. Participants are re-interviewed whether they are re-incarcerated or back in the community. Using data collected in prior phases and the additional interviews, we will examine patterns of drug use, drug use disorder, HIV/AIDS risk and infection from adolescence (ages 10-17 years) to emerging adulthood (ages 18-24 years) and young adulthood (age 25 and older). Our Specific Aims focus on 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) affect the following: (1) drug use behaviors (including the number and types of substances used, frequency of use, and route of administration) and drug use disorders (onset, persistence, desistance, and recurrence);(2) HIV/AIDS sex risk behaviors (including unprotected anal or vaginal receptive sex and trading sex for drugs) and injection-risk behaviors;(3) prevalence and incidence of HIV infection and other STIs;(4) the relationship between patterns of drug use and disorder and HIV/AIDS risk behaviors, especially how risk and protective factors predict, moderate, and mediate these relationships. This study responds to the initiatives of NIDA, NIAAA, and other NIH institutes to reduce health disparities in HIV/AIDS in minority populations.

DESCRIPTION (provided by applicant): 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 the effect of incarceration on HIV/AIDS. Most studies of incarcerated populations are cross-sectional and provide limited information on the effects of incarceration. To continue to address this key omission in the literature, we propose to extend the Northwestern Juvenile Project, a longitudinal study of 1829 juvenile justice youth, enrolled at age 10-18 years (1172 males, 657 females; 1005 African Americans, 296 non-Hispanic whites, 524 Hispanics, and 4 other race/ethnicity). Currently, the HIV/AIDS component of the project (RO1 DA022953) includes only a subsample (n=743) and 10-, 11-, 12-, and 13-year follow-up interviews. We now propose to (1) study the entire sample (originally 1829, now 1678); (2) conduct 3 additional annual interviews (14-, 15-, and 16-year follow-ups), at which time participants will be aged 26-34 years; (3) collect official records to cross-validate self-reported data (on STI status, arrests, incarceration history, and services received); (4) test the entire sample for HIV infection, chlamydia, and gonorrhea; and (5) administer a new module on incarceration, release, and re-entry. Participants are re-interviewed whether they are re-incarcerated or back in the community. Using data collected in prior phases and the additional interviews, we will examine patterns of drug use, drug use disorder, HIV/AIDS risk and infection from adolescence (ages 10-17 years) to emerging adulthood (ages 18-24 years) and young adulthood (age 25 and older). Our Specific Aims focus on 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) affect the following: (1) drug use behaviors (including the number and types of substances used, frequency of use, and route of administration) and drug use disorders (onset, persistence, desistance, and recurrence); (2) HIV/AIDS sex risk behaviors (including unprotected anal or vaginal receptive sex and trading sex for drugs) and injection-risk behaviors; (3) prevalence and incidence of HIV infection and other STIs; (4) the relationship between patterns of drug use and disorder and HIV/AIDS risk behaviors, especially how risk and protective factors predict, moderate, and mediate these relationships. This study responds to the initiatives of NIDA, NIAAA, and other NIH institutes to reduce health disparities in HIV/AIDS in minority populations.

Every year in the United States, more than 900,000 juveniles are arrested and approximately 250,000 court cases result in incarceration. Racial/ethnic minority youth and adults are disproportionately incarcerated, especially for drug crimes. To address health inequities, we are currently conducting the Northwestern Juvenile Project (NJP), a 16-year longitudinal study of health outcomes of youth after detention. Substance use disorders (SUDs) were the most common psychiatric disorders at detention (affecting about one-half of males and females), the most common comorbid disorder, and the most persistent disorder, affecting 1 in 5 participants in young adulthood. Many delinquent youth become parents when young; their offspring are at great risk for SUDs and related problem behaviors. The proposed investigation, the Northwestern Offspring Project, will be the first prospective study of intergenerational transmission of SUDs in the children of delinquent youth. The Northwestern Offspring Project addresses the limitations of prior intergenerational studies, many of which were conducted overseas and therefore unable to address health inequities in the United States. We propose to study n=428 offspring (ages 12-15 years), their parents, n=428, and an additional primary caregiver, estimated n=261. We chose ages 12-15 years because it is a critical developmental period for substance abuse. Leveraging prospective data that have already been collected on parents (up to 14 interviews), the Specific Aims will investigate: (1) intergenerational transmission of substance use, SUDs, and related problem behaviors in offspring; (2) mechanisms of intergenerational transmission, focusing on the exposure of the child to the parents' substance abuse and to the collateral consequences of the parents' incarcerations; and (3) resilience, examining the protective effect of a supportive and prosocial environment. The proposed investigation is innovative by focusing on: (1) parents who have been in the correctional system; (2) the consequences of incarceration; (3) African Americans and Hispanics, groups that are disproportionately incarcerated and who face the most serious consequences of drug abuse; (4) use and disorder, examining 10 subcategories of substances: marijuana, cocaine, hallucinogen/PCP, opioid, amphetamine, inhalant, sedative, unspecified drug, alcohol, and tobacco; (5) resilience to intergenerational transmission in an exceptionally high-risk population; (6) patterns of homotypic and heterotypic continuity. The proposed study responds to (1) the National Academy of Medicine's call for translational research to address the social determinants of health disparities; (2) the NIMHD Strategic Plan, which requests studies to address disparities in the causal factors of substance abuse; (3) the NIAAA Health Disparities Strategic Plan to build a knowledge base for populations that have received less attention in studies of alcohol abuse; and (4) the NIDA 2016-2020 Strategic Plan to identify environmental, behavioral, and social causes and consequences of addiction and determine mechanisms that underlie individual risk and resilience for addiction.

PROJECT SUMMARY/ABSTRACT Firearm violence is an urgent public health problem. Despite declines in homicide and other violent crime, firearms were involved in the crime-related deaths of more than 350,000 people in the United States in the past decade. Young urban racial/ethnic minorities are disproportionately affected. In the Northwestern Juvenile Project (NJP), our 16-year longitudinal study of juvenile offenders, we found that a large proportion owned a gun, perpetrated firearm violence, and/or were victims of firearm violence. Many juvenile offenders become parents when young; their children are at great risk for firearm involvement and victimization. Yet there are remarkably few data on how parents' involvement with firearms?during their own adolescence and young adulthood?influences their children's risk. We propose to leverage prospective data?already collected on our original participants?to conduct the first large-scale study of how high-risk parents' current and past involvement with firearms (ownership, perpetration of violence, and victimization) influences that of their adolescent children. We will interview 900 participants: n=450 high-risk youth (children of adolescent offenders), ages 12 to 15 years, and their parents, n=450. We chose ages 12 to 15 years because it is a critical developmental period for the initiation of firearm involvement. We have 4 aims: (1) to examine patterns of firearm involvement in urban high-risk adolescents (children of juvenile offenders, G2); (2) to examine their parents' (G1) involvement with firearms; (3) to examine how parents' firearm involvement influences that of their children; and (4) to identify risk and protective factors that moderate and mediate the relationship between the parent and child's involvement with firearms. The proposed prospective study has several key features: (1) the sample will include enough parents with a history of involvement with firearms (including victimization and perpetration) to examine its influence on their children; (2) the sample is predominantly socioeconomically disadvantaged African Americans and Hispanics, groups who face the most grievous consequences of firearm violence; (3) the design will allow us to examine multilevel data on risk and protective factors from individuals, families, peers, and communities; and (5) the study uses a mixed-methods approach to identify protective factors that could be used as targets for developing innovative preventive interventions. The investigation will provide data responding to: (1) the National Academy of Medicine's priorities for research to reduce the threat of firearm-related violence; (2) Healthy People 2020's objective to reduce firearm-related deaths or reduce weapon carrying by adolescents on school property; and (3) and the Centers for Disease Control and Prevention's priority to identify and evaluate strategies to decrease inappropriate access to and use of weapons by minors, and to prevent lethal violence.

PROJECT SUMMARY/ABSTRACT More than 2.2 million people?disproportionately racial/ethnic minorities?are incarcerated in the U.S. More than half of males and nearly 2/3 of females in prison have children. Racial/ethnic disparities prevail: 1 in 9 African American children and 1 in 28 Hispanic children have a parent in prison compared with 1 in 56 non-Hispanic white children. Incarceration, whether or not it occurs during the child's lifetime, may disrupt families, alienate loved ones, and limit opportunities for employment, public housing, college admission, public aid, and some occupations, leading to poverty and residential instability. Incarceration during the child's lifetime may have direct consequences for the child: a new caregiver, moving homes, changing schools, or placement in foster care. Despite the importance of data addressing these health inequities, no comprehensive study has examined the consequences of parents' incarceration on their children. Prior studies, for example, assessed parents' incarceration only globally (e.g., ?yes/no,?); could not analyze the frequency and duration of incarceration; conflated jail (pretrial and sentences <1 year) and prison (convicted felons, >1 year), and did not examine collateral consequences. We will leverage data already collected in the Northwestern Juvenile Project (NJP) to conduct the first comprehensive prospective study of the collateral consequences of parents' incarcerations on their adolescent children. Begun in the mid-1990s, the NJP is a large-scale longitudinal study of mental health needs and outcomes of youth after detention. Many of our participants (G1), now median age 36, have children of their own, with whom we have maintained contact since 2002. We will study 466 families with children (G2) ages 10 to 17 years, a critical developmental period for problem behaviors. We will (1) use prospective longitudinal data from the NJP (up to 14 clinical interviews with parents and official records); (2) conduct new interviews with parents (n = 466) and an additional caregiver (n = 284) to ascertain collateral consequences of incarcerations and child outcomes; (3) interview the 466 children to ascertain their psychosocial functioning and experiences; and (4) conduct qualitative interviews (n = 48 children) to assess their experiences of their parents' incarceration. The proposed study has 3 aims: (1) To examine the relationship between parents' incarceration and their child's psychosocial outcomes in 4 areas: mental health, substance abuse, antisocial (delinquent) behaviors, and education; (2) To identify how the collateral consequences of incarceration mediate the associations found in Aim 1; and (3) To predict resilience, identifying variables that mitigate consequences of parents' incarceration on child outcomes; we will focus especially on malleable aspects of social environments. The proposed study responds to (1) Healthy People 2030, which promotes health equity and elimination of health disparities; (2) the Strategic Plan of NIMHD to reduce health disparities; (3) the Strategic Plans of NIDA and NIAAA to address the causes and consequences of drug and alcohol abuse; and, (4) NICHD's mission for all children to lead healthy, productive lives.

PROJECT SUMMARY/ABSTRACT This proposal responds to RFA-CE-20-006, Objective One, Funding Option B. Firearm violence is an urgent public health problem. Despite declines in homicide and other violent crime, firearms were involved in the crime-related deaths of more than 140,000 people in the United States from 2008 to 2018. Youth in the juvenile justice system are disproportionately affected by firearm violence. Many juvenile offenders become parents when young; their children are likely to be at significant risk for firearm involvement and victimization. Yet there are remarkably few data on how parents? involvement with firearms, during their own adolescence and young adulthood, influences their children?s risk. We designed Next Generation, funded by the National Institute of Child Health, Human Development the National Institute of Justice, and other agencies to address this and other key omissions. Leveraging prospective data already collected on our original participants, Next Generation includes the first prospective study of how high-risk parents? current and past involvement with firearms (ownership, perpetration of violence, and victimization) influences that of their adolescent children. This study, however, samples only one child per family. We propose that the CDC augment our intergenerational study of firearms to add siblings. We propose to add 532 interviews: 165 with siblings and 367 additional interviews with their parents and secondary caregivers. Total N of the proposed study of firearms would then be 1,585: 709 children plus 544 parents and 332 secondary caregivers. Funding from the CDC will allow us to address three aims: Aim 1: to examine patterns of firearm involvement focusing on patterns of concordance and discordance between siblings. Aim 2: to examine the influence of parents? (G1) firearm involvement on their children?s involvement (G2), focusing on differences between siblings in this relationship. Aim 3: to identify risk and protective factors that explain within- and between-family differences. The proposed prospective study has several key features: (1) the sample will include enough parents with a history of involvement with firearms (including victimization and perpetration) to examine the influence on their children and differences between siblings; (2) the sample is composed predominantly of socioeconomically disadvantaged African Americans and Hispanics, groups that face the most grievous consequences of firearm violence; and (3) the design will provide multilevel data to identify the risk and protective factors that explain why one sibling is able to avoid firearm involvement while the other is not. Findings will guide the development and adaptation of preventive interventions for the highest risk families. We will provide data responding to the CDC?s priority of identifying strategies to decrease inappropriate access to and use of weapons by minors and to prevent lethal violence.

We are currently funded by NIMHD (R01MD014020) to study the consequences of parents? incarceration for their children. In this competitive revision, we request funds to add an interview module to study the consequences of the COVID-19 pandemic in our high-risk, underserved, racially/ethnically diverse sample of people who have been incarcerated (G1) and their children (G2); 68% of our participants are African American, and 25% are Hispanic. The parents (G1) are the original participants of the Northwestern Juvenile Project (NJP), begun in the late 1990s. The NJP is the only large-scale longitudinal study of mental health needs and outcomes of youth after detention. We collected detailed data on the parents ? including information on incarceration, mental health, substance abuse, employment, and housing ? from adolescence (ages 10?18) through a median age of 32. Although all G1 were detained at least once during adolescence, they are diverse in their subsequent patterns of incarceration: 35% have not been incarcerated since adolescence, 25% have been incarcerated in jail only, and 40% have been incarcerated in both jail and prison. The proposed competitive revision will leverage data already collected on 466 parents, since 1995, as part of the NJP (4,500 interviews, up to 14 interviews per person), as well as data currently being collected in R01MD014020 on parents, a focal child (aged 10?17 years), and caretakers. The new interview module will allow us to pursue the following aims: Aim 1, Consequences: To identify the consequences of the COVID-19 pandemic and associated containment and mitigation strategies. We will assess changes in (a) Familial, social, and financial well-being: work and income; food and financial insecurity; living arrangements; changes in children?s education and childcare; and shifting responsibilities of parents and children, and (b) Health and behavioral problems: COVID-19 infection, parental substance abuse, child behavior problems, and family functioning (shared activities, conflict, relationship instability). Most importantly, we will assess how these consequences vary by race/ethnicity, recency of incarceration, and the severity of the offense(s) that precipitated incarceration (misdemeanor or felony). Aim 2, Resilience: Incorporating extensive data on resilience measured in R01MD014020, we will determine which variables reduce the negative consequences of the pandemic (identified in Aim 1). We will focus on malleable protective factors, including social support, receipt of cash benefits and in-kind benefits, neighborhood environment (assessed via self-report and geocoding, e.g., population density, neighborhood cohesion, neighborhood violence, neighborhood income level) and personal attitudes and behaviors around mitigation strategies. Identifying how vulnerable families are impacted by and cope with COVID-19 will better prepare our country?s health, economic, and social service systems to support them now and in the future. This application responds to (1) NOT-MD-20-019, Competitive and Administrative Supplements for the Impact of COVID-19 Outbreak on Minority Health and Health Disparities; (2) the goal of Healthy People 2030 to promote health equity and eliminate health disparities; and (3) the Strategic Plan of NIMHD to reduce health disparities and improve minority health.