Racial and ethnic differences in the availability of community medical services after leaving prison.

INTRODUCTION: Incarcerated individuals experience increased health problems, presenting additional challenges as they leave prison and re-enter the community. These challenges are disproportionally experienced by racial and ethnic minorities. Despite these trends, little is known regarding the availability of medical services within the communities to which incarcerated individuals return. METHODS: We examined all prison returns in the state of Florida between 2008 and 2017. We examined the odds of returning from prison to a community that is formally designated as medically underserved by the Health Resources and Services Administration. We also examined whether Florida communities with a greater proportion of racial and ethnic minority returns were more likely to be designated as medically underserved. RESULTS: Overall, each SD increase in community return rate resulted in a 20% increase in the odds of medical underservice designation. For each SD increase in the proportion of black and Latino returns, the odds of medical underservice designation increased by 50% and 14%, respectively, compared with the proportion of white returns. DISCUSSION: Within Florida, previously incarcerated individuals are more likely to return to communities with limited availability of medical services. These findings are even more pronounced for communities with more black returnees. Previously incarcerated individuals are more likely to return to communities that lack the medical infrastructure required to address their unique healthcare needs, potentially leading to worsened health, and increased racial and ethnic health disparities.

The longitudinal associations between bullying perpetration, bullying victimization, and internalizing symptoms: Bidirectionality and mediation by friend support.

Internalizing symptoms have been linked to bullying perpetration and victimization in adolescence. However, the directions of any causal relationships remain unclear, and limited research has identified the mechanisms that explain the associations. Given the salience of peer relationships during the teenage years, we examine whether perceived support from friends is one such mechanism. By using a transactional framework and four waves of longitudinal panel data on over 900 youth, we test both cross-lagged and indirect associations between bullying perpetration, bullying victimization, internalizing symptoms, and perceived friend support. Our method represents one of the most rigorous tests to date of the mutual influences among these factors. The results show that internalizing symptoms and perceived friend support were reciprocally linked to bullying victimization, but perceived support did not predict internalizing symptoms, and bullying perpetration neither preceded nor followed perceived support or internalizing symptoms. There were no significant indirect paths between bullying involvement and internalizing symptoms through perceived friend support. The results provide only partial support for a transactional model in which bullying victimization, support, and internalizing symptoms are reciprocally related. The implications of these findings for theory, future research, and practice are discussed.

Consequences of Victimization on Perceived Friend Support during Adolescence.

Victimization can harm youth in various ways and negatively affect their friendships with peers. Nevertheless, not all victimized youth are impacted similarly, and the literature is unclear regarding why some victims are more likely than others to experience friendship-based consequences. Using five waves of data on 901 adolescents (6th grade at wave 1; 47% male; 88% White) and a subsample of 492 victimized youth, this study assessed (1) whether victimization leads to decreases in perceived friend support, and (2) the factors that explain which victimized youth are most likely to experience decreases in perceived friend support. Explanatory factors included subsequent victimization, victims' social network status (self-reported number of friends, number of friendship nominations received), and victims' risky behaviors (affiliating with deviant friends, delinquency, aggression, binge drinking). Random effects regressions revealed that, among the full sample, victimization was linked to decreases in friend support. Among victimized youth, subsequent victimization and deviant friends decreased friend support. Having more friends was associated with increased friend support among victims, though this association weakened as the number of friends increased. The results emphasize that victimized youth are a heterogeneous group with varying risks of experiencing friendship-based consequences.

Youth with Co-occurring Delinquency and Depressive Symptoms: Do They Have Better or Worse Delinquent Outcomes?

Delinquent youth often experience depression, but depression's impact on their future deviance is unclear. Using survey and social network data on a panel of 9th graders (N = 8701; Mage at baseline = 15.6; 48% male; 85% white; 18% eligible for free or reduced-price school lunch) followed throughout high school, this study tested whether depressive symptoms predicted later deviance or deviant peer affiliations among already delinquent youth. A latent class analysis revealed that 4% of respondents showed above-average levels of delinquency but not depressive symptoms, and 3% were above average on both. Compared to the delinquent-only group, the delinquent-depressed group went on to have less deviant friends, and to engage in less deviance themselves. However, peer deviance was not a reliable explanation for the reductions in respondents' own future deviance. Depressive symptoms thus may play a protective role against continued delinquency and substance use among youth who are already delinquent, but it is not because they reduce deviant peer affiliations.

Adolescent Internalizing Symptoms and the "Tightknittedness" of Friendship Groups.

Adolescents with depression have lower peer status overall, but tend to befriend each other. We examined the "tightknittedness" of their friendship groups by testing whether adolescent friendship groups' average levels of or variability in internalizing symptoms predict group cohesiveness. We used four waves (9th-12th grades) of survey and social network data on 3,013 friendship groups from the PROmoting School-Community-University Partnerships to Enhance Resilience study. Friendship groups with higher average depressive symptoms were less cohesive; groups with higher average anxiety symptoms had greater reciprocity. Groups with greater variability in depressive symptoms had greater density; variability in anxiety symptoms was not consistently associated with cohesion. The friendship groups of depressed adolescents appear less cohesive than the "typical" adolescent friendship group.

Social Ties Cut Both Ways: Self-Harm and Adolescent Peer Networks.

Peers play an important role in adolescence, a time when self-harm arises as a major health risk, but little is known about the social networks of adolescents who cut. Peer network positions can affect mental distress related to cutting or provide direct social motivations for self-harm. This study uses PROSPER survey data from U.S. high school students (n = 11,160, 48% male, grades 11 and 12), finding that social networks predict self-cutting net of demographics and depressive symptoms. In final models, bridging peers predicts higher self-cutting, while claiming more friends predicts lower cutting for boys. The findings suggest that researchers and practitioners should consider peer networks both a beneficial resource and source of risk associated with cutting for teens and recognize the sociostructural contexts of self-harm for adolescents more broadly.

Social Exclusion and Parental Incarceration Impacts on Adolescents' Networks and School Engagement.

Although prior research links parental incarceration to deleterious outcomes for children over the life-course, few studies have examined whether such incarceration affects the social exclusion of children during adolescence. Drawing on several lines of scholarship, we examine whether adolescents with incarcerated parents have fewer or lower quality relationships, participate in more antisocial peer networks, and feel less integrated or engaged in school. The study applies propensity score matching to survey and network data from a national sample of youth. Analyses indicated that children with incarcerated parents have more antisocial peers; we found limited evidence, though, that parental incarceration adversely impacts peer networks and school integration domains. Generally, the results suggested that the impacts of parental incarceration on adolescents' social lives have less to do with isolation than with the types of peers adolescents befriend. Findings provide support for the idea that parental incarceration may adversely affect children's social exclusion.

New Students' Peer Integration and Exposure to Deviant Peers: Spurious Effects of School Moves?

School moves during adolescence predict lower peer integration and higher exposure to delinquent peers. Yet mobility and peer problems have several common correlates, so differences in movers' and non-movers' social adjustment may be due to selection rather than to causal effects of school moves. Drawing on survey and social network data from a sample of 7th and 8th graders, this study compared the structure and behavioral content of new students' friendship networks to those of not only non-movers, but also of students about to move schools; the latter should resemble new students in both observed and unobserved ways. The results suggest that the association between school moves and friends' delinquency is due to selection, but the association between school moves and peer integration may not be entirely due to selection.

Early Sexual Initiation and Mental Health: A Fleeting Association or Enduring Change?

The present research examined how the within-person association between sexual initiation and internalizing symptoms decays over time, using data with annual measurement occasions across adolescence (N = 1,789) and statistical models of within-person change. Sexual initiation was associated with increased levels of internalizing symptoms for early-initiating girls (ninth grade, approximately age 15), but not for on-time-initiating girls or for boys. The association between girls' early sexual initiation and internalizing symptoms declined precipitously over time. Indeed, 1 year after sexual debut, early-initiating girls were similar to on-time or noninitiating girls on internalizing symptoms, suggesting early sexual initiation does not produce lasting detriments to girls' mental health. Findings inform how researchers perceive sexual initiation, both as a developmental milestone and as a prevention target.

Risk Factors for Substance Misuse and Adolescents' Symptoms of Depression.

PURPOSE: Depressive symptoms during adolescence are positively associated with peer-related beliefs, perceptions, and experiences that are known risk factors for substance misuse. These same risk factors are targeted by many universal substance misuse prevention programs. This study examined whether a multicomponent universal substance misuse intervention for middle schoolers reduced the associations between depressive symptoms, these risk factors, and substance misuse. METHODS: The study used data from a place-randomized trial of the Promoting School-Community-University Partnerships to Enhance Resilience model for delivery of evidence-based substance misuse programs for middle schoolers. Three-level within-person regression models were applied to four waves of survey, and social network data from 636 adolescents followed from sixth through ninth grades. RESULTS: When adolescents in control school districts had more symptoms of depression, they believed more strongly that substance use had social benefits, perceived higher levels of substance misuse among their peers and friends, and had more friends who misused substances, although they were not more likely to use substances themselves. Many of the positive associations of depressive symptoms with peer-related risk factors were significantly weaker or not present among adolescents in intervention school districts. CONCLUSIONS: The Promoting School-Community-University Partnerships to Enhance Resilience interventions reduced the positive associations of adolescent symptoms of depression with peer-related risk factors for substance misuse.

Internalizing Symptoms, Peer Substance Use, and Substance Use Initiation.

This study used longitudinal survey and social network data covering sixth through ninth grades to test whether internalizing symptoms make early adolescents more prone to (1) exposure to and (2) influence by substance-using peers. Random effects regressions revealed that increases in symptoms were significantly associated with increases in the proportion of friends who used cigarettes, alcohol, and marijuana; some associations weakened across grades. Event history models revealed that the effect of friends' smoking on smoking initiation decreased as internalizing symptoms increased; symptoms did not moderate the effects of friends' alcohol and marijuana use on alcohol and marijuana use initiation. These findings counter the influence hypothesis of the co-occurrence of internalizing symptoms with substance use and partly support the exposure hypothesis.

PARTNERSHIP TRANSITIONS AND ANTISOCIAL BEHAVIOR IN YOUNG ADULTHOOD: A WITHIN-PERSON, MULTI-COHORT ANALYSIS.

OBJECTIVES: This study examines the effects of young adult transitions into marriage and cohabitation on criminal offending and substance use, and whether those effects changed since the 1970s as marriage rates declined and cohabitation rates rose dramatically. It also examines whether any beneficial effects of cohabitation depend on marriage intentions. METHODS: Using multi-cohort national panel data from Monitoring the Future (N = 15,875), the authors estimated fixed effects models relating within-person changes in marriage and cohabitation to changes in criminal offending and substance use. RESULTS: Marriage predicts lower levels of criminal offending and substance use, but the effects of cohabitation are limited to substance use outcomes and to engaged cohabiters. There are no cohort differences in the associations of marriage and cohabitation with criminal offending, and no consistent cohort differences in their associations with substance use. There is little evidence of differences in effects by gender or parenthood. CONCLUSIONS: Young adults are increasingly likely to enter romantic partnership statuses that do not appear as effective in reducing antisocial behavior. Although cohabitation itself does not reduce antisocial behavior, engagement might. Future research should examine the mechanisms behind these effects, and why non-marital partnerships reduce substance use and not crime.

EXPLAINING THE ASSOCIATION BETWEEN INCARCERATION AND DIVORCE.

Recent studies have suggested that incarceration dramatically increases the odds of divorce, but we know little about the mechanisms that explain the association. This study uses prospective longitudinal data from a subset of married young adults in the National Longitudinal Study of Adolescent Health (N = 1,919) to examine whether incarceration is associated with divorce indirectly via low marital love, economic strain, relationship violence, and extramarital sex. The findings confirmed that incarcerations occurring during, but not before, a marriage were associated with an increased hazard of divorce. Incarcerations occurring during marriage also were associated with less marital love, more relationship violence, more economic strain, and greater odds of extramarital sex. Above-average levels of economic strain were visible among respondents observed preincarceration, but only respondents observed postincarceration showed less marital love, more relationship violence, and higher odds of extramarital sex than did respondents who were not incarcerated during marriage. These relationship problems explained approximately 40 percent of the association between incarceration and marital dissolution. These findings are consistent with theoretical predictions that a spouse's incarceration alters the rewards and costs of the marriage and the relative attractiveness of alternative partners.

Still the Favorite? Parents' Differential Treatment of Siblings Entering Young Adulthood.

This study examined within-family stability in parents' differential treatment of siblings from adolescence to young adulthood and the effect of differential treatment in young adulthood on grown siblings' relationship quality. The author used longitudinal data on parent - child and sibling relations from the sibling sample of the National Longitudinal Study of Adolescent Health (N = 1,470 sibling dyads). Within-dyad fixed effects regression models revealed that the adolescent sibling who was closer to parents went on to be the young adult sibling who was closer to and received more material support from parents. Results from an actor - partner interdependence model revealed that differential parental financial assistance of young adult siblings predicted worse sibling relationship quality. These findings demonstrate the lasting importance of affect between parents and offspring earlier in the family life course and the relevance of within-family inequalities for understanding family relations.

THE CODE OF THE STREET AND INMATE VIOLENCE: INVESTIGATING THE SALIENCE OF IMPORTED BELIEF SYSTEMS.

Scholars have long argued that inmate behaviors stem in part from cultural belief systems that they "import" with them into incarcerative settings. Even so, few empirical assessments have tested this argument directly. Drawing on theoretical accounts of one such set of beliefs-the code of the street-and on importation theory, we hypothesize that individuals who adhere more strongly to the street code will be more likely, once incarcerated, to engage in violent behavior and that this effect will be amplified by such incarceration experiences as disciplinary sanctions and gang involvement, as well as the lack of educational programming, religious programming, and family support. We test these hypotheses using unique data that include measures of the street code belief system and incarceration experiences. The results support the argument that the code of the street belief system affects inmate violence and that the effect is more pronounced among inmates who lack family support, experience disciplinary sanctions, and are gang involved. Implications of these findings are discussed.

Hanging Out with Which Friends? Friendship-Level Predictors of Unstructured and Unsupervised Socializing in Adolescence.

Companions are central to explanations of the risky nature of unstructured and unsupervised socializing, yet we know little about whom adolescents are with when hanging out. We examine predictors of how often friendship dyads hang out via multilevel analyses of longitudinal friendship-level data on over 5,000 middle schoolers. Adolescents hang out most with their most available friends and their most generally similar friends, not with their most at-risk or similarly at-risk friends. These findings vary little by gender and wave. Together, the findings suggest that the risks of hanging out stem from the nature of hanging out as an activity, not the nature of adolescents' companions, and that hanging out is a context for friends' mutual reinforcement of pre-existing characteristics.

Project ALERT with outside leaders: what leader characteristics are important for success?

A previously published effectiveness study of Project ALERT delivered in schools by outside providers from Cooperative Extension found no positive effects for the adult or teen-assisted delivery of the curriculum despite high-quality implementation. Those findings and the likelihood that more outside providers will deliver evidence-based drug prevention programs in the future, led to this investigation of possible influences of leaders' personal characteristics on ALERT's program effects. Influence of leader characteristics on students' drug use and mediating variables for use were assessed by modeling program effects on within-student change as a function of leader characteristics. Students in classrooms with adult leaders who were more conscientious, sociable, or individuated were more likely to experience beneficial program effects. Students in teen-assisted classrooms with teen leaders who were more sociable or, to a lesser extent, highly individuated, showed more positive effects. Implications for research and practice are discussed.

Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part II.

OBJECTIVE: To develop treatment recommendations for the use of antipsychotic medications for children and adolescents with serious psychiatric disorders and externalizing behavior problems. METHOD: Using a combination of evidence- and consensus-based methodologies, recommendations were developed in six phases as informed by three primary sources of information: (1) current scientific evidence (published and unpublished), (2) the expressed needs for treatment-relevant information and guidance specified by clinicians in a series of focus groups, and (3) consensus of clinical and research experts derived from a formal survey and a consensus workshop. RESULTS: Fourteen treatment recommendations on the use of atypical antipsychotics for aggression in youth with comorbid psychiatric conditions were developed. Each recommendation corresponds to one of the phases of care (evaluation, treatment, stabilization, and maintenance) and includes a brief clinical rationale that draws upon the available scientific evidence and consensus expert opinion derived from survey data and a consensus workshop. CONCLUSION: Until additional research from controlled trials becomes available, these evidence- and consensus-based treatment recommendations may be a useful approach to guide the use of antipsychotics in youth with aggression.

Antipsychotics for aggressive adolescents: barriers to best practice.

In adolescents, antipsychotics are most often used to treat complex, comorbid conditions with core disruptive features. However, the literature guiding such practices is limited. Best practice guidelines bridging the gap between the evidence and clinical practice have been developed to promote the appropriate and safe use of antipsychotics in aggressive youths. Due to complex barriers that exist at the level of the physician, patient/family and organization, merely disseminating these guidelines will not likely change antipsychotic prescribing practices. Negative attitudes, time constraints, lack of staff training and resources, or adolescent/family nonadherence can impede the translation of best practice guidelines into routine practices. Efforts to implement best practice guidelines must address these barriers if changes in prescribing practices are to occur and be sustained.