1 00:00:00,060 --> 00:00:06,960 Nothing but mental health needs and other outcomes of kids in the juvenile justice system. 2 00:00:08,790 --> 00:00:17,219 Now, when I first went to develop funding for this, of course, the funding agencies were funded mostly by NIH, 3 00:00:17,220 --> 00:00:22,080 which is National Institutes of Health in the U.S. and other federal agencies. 4 00:00:22,560 --> 00:00:26,640 And they said to me, Well, sounds like an interesting study, 5 00:00:27,060 --> 00:00:36,540 but aren't kids like yours already included in all the large scale general population studies that we already fund? 6 00:00:37,320 --> 00:00:48,090 Very good question. And I thought about it and I realised that delinquent kids are not part of school based studies. 7 00:00:48,750 --> 00:00:54,210 You know, think about how how do we draw samples when media studies many people use school based samples. 8 00:00:54,510 --> 00:01:02,130 Well, if you've got delinquent kids who are truant or incarcerated, they are not part of those school based studies. 9 00:01:03,750 --> 00:01:08,910 Another way we collect data on general populations is household based surveys. 10 00:01:09,810 --> 00:01:20,280 But again, kids like ours, kids in the juvenile justice system wouldn't be part of those samples either, very much, very often, 11 00:01:20,520 --> 00:01:30,720 because they are usually from very poor families, highly mobile, unlikely to be sampled or again detained and therefore unavailable. 12 00:01:31,740 --> 00:01:41,490 And then I found out and I discovered this by actually calling all the principal investigators of large scale studies funded by NIH in the U.S. 13 00:01:41,970 --> 00:01:49,590 I called people and I said, Tell me, do you sample from detention centres? 14 00:01:49,980 --> 00:02:00,210 And the answer was always no. And then I said, And do you retain people at follow up if they become incarcerated? 15 00:02:01,050 --> 00:02:05,010 And everyone said, Oh, no, we can't do that. 16 00:02:05,520 --> 00:02:07,020 So here we have a situation. 17 00:02:07,020 --> 00:02:14,190 And again, this is a great lesson for the trainees who are looking for holes in the literature, looking for key omissions in the literature, 18 00:02:14,580 --> 00:02:23,790 where we have a situation where a group that is probably likely to have the greatest mental health needs and the 19 00:02:23,790 --> 00:02:32,999 worst outcomes is not only not sampled but lost to follow up so that all of the studies that you see in the U.S., 20 00:02:33,000 --> 00:02:42,720 whether they're on psychiatric disorders like the National Comorbidity Survey or on cardiac disease or cancer, 21 00:02:43,080 --> 00:02:51,810 none of those studies include incarcerated people because they're not sampled and all the incarcerated people are lost to follow up. 22 00:02:52,230 --> 00:02:56,310 It's really quite an and it was quite an amazing, amazing revelation to me. 23 00:02:56,760 --> 00:03:06,630 And it was it became the argument actually with our funding agencies for why they should fund the Northwestern Juvenile Project, 24 00:03:06,930 --> 00:03:15,270 because this is a sample that they know has great mental health needs, dire health outcomes in many ways. 25 00:03:15,600 --> 00:03:24,000 And yet this group was not part of any study that they were currently funding or had ever funded. 26 00:03:24,600 --> 00:03:32,000 Ever funded. Let me explain now a little bit about why I'm so passionate about this study, 27 00:03:32,510 --> 00:03:37,910 because I think you can tell I'm not just American, but I really am very passionate about my work. 28 00:03:41,000 --> 00:03:44,810 I'm from Chicago and we're where we are. A bit histrionic in Chicago. 29 00:03:45,110 --> 00:03:49,460 By the way, is my accent. Okay, another one. 30 00:03:49,490 --> 00:03:53,500 Can you change? You know I love British accents. 31 00:03:53,510 --> 00:04:01,400 Do you know that in the U.S., if you have an applicant with an English accent and without, there's no question who they would hire. 32 00:04:01,500 --> 00:04:08,629 Absolutely. It is so impressive. And Americans can't even differentiate a country accent. 33 00:04:08,630 --> 00:04:13,550 From what? From a posh accent. From a Australian accent. 34 00:04:13,940 --> 00:04:21,800 So we know we're we're just hopelessly ignorant about those kinds of things, but we're very impressed by the right kind of accent. 35 00:04:24,230 --> 00:04:28,010 So why did I why am I so passionate about this study? 36 00:04:28,040 --> 00:04:39,050 Two reasons. First reason is just the sheer number of kids that are processed through the juvenile justice system in the United States. 37 00:04:40,130 --> 00:04:46,820 So what we see is that it hit a peak at about 1997 and it's dropped since then. 38 00:04:47,300 --> 00:04:54,830 But we still have about 1.3 million delinquency cases disposed in a year. 39 00:04:55,880 --> 00:05:05,910 1.3 million. This is a chart. 40 00:05:06,060 --> 00:05:10,020 By the way, I'm one of these presenters I don't flash and then you don't even know what it is. 41 00:05:10,410 --> 00:05:16,319 I'm a ponderous presenter because that's how I like to see slides. 42 00:05:16,320 --> 00:05:23,760 So and if I go too fast, just tell me. But I like to focus on it, discuss the point, give you a moment. 43 00:05:24,060 --> 00:05:27,470 So I'm not pausing because I can't think of what to say, but. 44 00:05:28,590 --> 00:05:32,819 But rather because I think it will. It is absorbed better if you're slower. 45 00:05:32,820 --> 00:05:42,810 And for trainees in the audience, I think that's the best way to present is show a slide, pause, let people see it, explain it, pause. 46 00:05:43,200 --> 00:05:49,260 Go on to the next one. Just. Just for trainees here. Took me, like 20 years to figure that out. 47 00:05:50,640 --> 00:05:56,760 So, by the way, how many trainees do we have in here? Training students? 48 00:05:56,940 --> 00:06:01,890 Yeah, students. Graduates. I mean, undergrads, graduates, postdocs. 49 00:06:01,950 --> 00:06:09,420 Okay. Quite a few. Great. All right. I'll try to save you the work that it took me to learn things. 50 00:06:09,690 --> 00:06:12,960 20 years postdoc and give you some tips in the lecture. 51 00:06:13,560 --> 00:06:21,060 Good. So this shows the one day account of kids who are incarcerated in the US. 52 00:06:21,480 --> 00:06:30,390 And so once again we see that it hit a horrific high of 170,000 in the late nineties and it's dropped. 53 00:06:30,990 --> 00:06:42,300 But still on an average day, there are 61,000 kids that are incarcerated in some sort of secure facility. 54 00:06:49,660 --> 00:06:58,270 The second reason that I'm so passionate about this area is because of disproportionate incarceration of racial and ethnic minorities, 55 00:06:58,780 --> 00:07:11,810 and especially of African-Americans. We have a situation today where millions of people are incarcerated in the U.S., two point on an average day. 56 00:07:11,830 --> 00:07:17,110 2.2 million people are incarcerated. And disproportionately, they are minorities. 57 00:07:17,920 --> 00:07:30,880 So what this shows what this slide shows is the proportion of kids in corrections and the proportion of adults in prisons who are African-American. 58 00:07:32,410 --> 00:07:38,830 And the sideways arrow shows the proportion it should be, which is 13%. 59 00:07:39,040 --> 00:07:47,470 In other words, African-Americans comprise 13% of the general population in the U.S., 60 00:07:48,130 --> 00:07:54,790 but about 40% of kids in detention and adults in jails and prisons. 61 00:08:01,260 --> 00:08:04,300 This is actually an appalling statistic. 62 00:08:04,320 --> 00:08:13,860 Also, this is from an article published in JAMA Journal of the American Medical Association about, oh, I think 12, 13 years ago. 63 00:08:14,310 --> 00:08:24,210 And they looked at a group of inner city, mostly African-American kids, and they wanted to see simply what proportion of them had been arrested. 64 00:08:24,720 --> 00:08:37,830 By age 18, they found that one in four poor African American inner city kids were arrested one or more times before age 18. 65 00:08:38,190 --> 00:08:46,460 One in four. I hope you can read this. 66 00:08:46,470 --> 00:08:50,580 This is probably one of the most appalling statistics that I ever present. 67 00:08:51,030 --> 00:08:54,120 And overseas audiences are especially appalled. 68 00:08:55,260 --> 00:08:59,220 These figures are from the United States Department of Justice, 69 00:09:00,120 --> 00:09:12,180 and they calculated the probability of being incarcerated one or more times in a state or federal prison over one's lifetime. 70 00:09:13,680 --> 00:09:17,280 They calculated it separately for males and for females. 71 00:09:18,810 --> 00:09:34,410 So what I would like to focus on is the top line, which is that one in three African Americans will be incarcerated in a state or federal prison. 72 00:09:34,440 --> 00:09:38,730 Now, this is not jail jail in the U.S. of something you call remand prisons. 73 00:09:39,210 --> 00:09:49,890 So this is prison. Prison. So one in three African-Americans will be incarcerated one or more times during their lifetime. 74 00:09:50,130 --> 00:09:54,630 One in three. I find this statistic shocking. 75 00:09:55,290 --> 00:10:01,200 That compares to one in 17 non-Hispanic white males. 76 00:10:01,980 --> 00:10:05,940 Hispanics now, you know, are the largest minority group in the United States. 77 00:10:06,270 --> 00:10:13,800 And even among Hispanics, it's one in six compared to African-Americans, where it's one in three. 78 00:10:14,910 --> 00:10:18,330 And then, of course, the rates are much, much lower among women. 79 00:10:18,330 --> 00:10:26,760 But you see the still you still see the same racial and ethnic differences where among African-American females, 80 00:10:26,760 --> 00:10:37,170 one in 18 will be incarcerated at some point in their life and compared to one in 200 non-Hispanic white females. 81 00:10:44,050 --> 00:10:51,010 So let me tell you a little bit about our study. It's actually a very straightforward study study. 82 00:10:51,160 --> 00:11:00,130 Today, I'll be focusing on psychiatric disorders, on positive outcomes and on negative outcomes. 83 00:11:01,090 --> 00:11:11,740 I'll also be suggesting some future directions for research, as well as talking about implications of our findings for public health policy. 84 00:11:12,550 --> 00:11:22,090 For me, what's kept me going over the years and in my work is that I joke my our articles don't just sit on my mother's coffee table, 85 00:11:22,540 --> 00:11:26,320 but they are used to guide national public health policy. 86 00:11:26,860 --> 00:11:35,170 And that's what's important, is that you choose work that will have relevance, that will have an impact on the field in some way. 87 00:11:35,800 --> 00:11:42,940 Although I must tell you that my mom used to complain. She would say she'd say, Honey, can't you write a book? 88 00:11:43,210 --> 00:11:49,530 The articles get so dusty on the coffee and we don't write books. 89 00:11:49,540 --> 00:11:58,599 I'm not I'm not a book kind of person. I'm like, you know, I do the perfect 4500 word manuscript, so I'm not a book kind of person. 90 00:11:58,600 --> 00:12:04,630 So she was always disappointed that I didn't have a book. So let me tell you a little bit about our study. 91 00:12:05,020 --> 00:12:09,729 It was really a very straightforward kind of investigation. 92 00:12:09,730 --> 00:12:21,010 Not a complicated design. Well, not complicated in theory, complicated in execution, as, of course, all of you who research subjects find. 93 00:12:21,850 --> 00:12:35,230 We started our study in 1995, and over about two and a half years, we drew a random sample of kids who were arrested and detained in Cook County. 94 00:12:36,790 --> 00:12:41,290 Ours is not a study of kids who perpetrate delinquent acts. 95 00:12:41,980 --> 00:12:49,000 We purposely chose kids who were in the juvenile justice system because our goal was to 96 00:12:49,000 --> 00:12:53,500 inform the juvenile justice system what they should be doing for kids in their care, 97 00:12:54,370 --> 00:13:02,050 and then also to inform the community mental health system about what they should do after these kids return. 98 00:13:03,160 --> 00:13:15,100 So we sampled kids when they entered, had just been arrested and detained at the Cook County Detention Centre and we chose their Cook County, 99 00:13:15,100 --> 00:13:27,940 by the way, as in Chicago, we chose Chicago not merely because it was convenient, but because and we thought a lot about where we should collect data. 100 00:13:29,020 --> 00:13:33,670 But when you choose a research site, you want it to be representative. 101 00:13:34,210 --> 00:13:38,830 And Chicago's so typical. It's a typical big city, typical big city problems. 102 00:13:39,250 --> 00:13:45,130 And so we felt it was a very good place to collect data because the kids would be pretty typical. 103 00:13:46,030 --> 00:13:58,030 We also investigated the legal structure and found that the criteria for detention was similar in Illinois to most states nationwide. 104 00:13:58,030 --> 00:13:59,770 So that was very advantageous. 105 00:14:01,330 --> 00:14:09,940 We also like Chicago because, as I mentioned, Hispanics are now the largest ethnic group in the U.S. and we wanted to study Hispanics. 106 00:14:11,080 --> 00:14:16,360 The problem is, of course, that if you studied Miami, you would get only Cuban-Americans. 107 00:14:17,080 --> 00:14:21,190 If you studied in New York, you would get pretty much only Puerto Rican folks. 108 00:14:21,640 --> 00:14:25,090 And if you study L.A., you would get mostly Mexican-Americans. 109 00:14:25,750 --> 00:14:32,690 Chicago's terrific because we have great diversity within our Hispanic population. 110 00:14:32,740 --> 00:14:42,820 And so that was advantageous for us as well. The last reason we chose Chicago and this is not inconsequential is that we could do it in Chicago. 111 00:14:43,420 --> 00:14:53,350 A study like this requires tremendous cooperation from everybody, from folks who work at the detention centre, the line staff, 112 00:14:53,350 --> 00:15:03,880 the chief judge of juvenile court, the chief judge of the entire circuit court, people who run Cook County jail, the prison system. 113 00:15:04,330 --> 00:15:07,570 You need tremendous cooperation from all of these places. 114 00:15:07,960 --> 00:15:16,690 And because I've been doing this kind of work for so many years, I know people and they know that I'm not a jerk. 115 00:15:17,320 --> 00:15:24,160 They know that I will not hurt them. They know that I will not go public with a press release that makes them look bad. 116 00:15:24,880 --> 00:15:31,600 They know that I will not release a press release where it starts, where the lead on TV is. 117 00:15:31,900 --> 00:15:35,650 Jails, neglect, mentally ill, women. Details at ten. 118 00:15:36,190 --> 00:15:42,400 They know I won't do that. So that we could do our study in Chicago and in other places. 119 00:15:42,500 --> 00:15:49,070 It would have been more arduous. So for all those reasons, Chicago was really a great place for us to do our study. 120 00:15:50,840 --> 00:15:57,110 We randomly selected 829 kids as they entered detention. 121 00:15:58,190 --> 00:16:01,730 We oversampled whites. 122 00:16:02,270 --> 00:16:03,380 Now, isn't that ironic? 123 00:16:03,620 --> 00:16:09,800 We have to do a report every year for our funding agencies where we have to tell them how well we're doing in recruiting minorities. 124 00:16:10,880 --> 00:16:16,460 Minorities are no problem in our when you study jails and prisons, the problem is getting enough whites. 125 00:16:17,210 --> 00:16:18,710 So we oversampled whites. 126 00:16:19,640 --> 00:16:28,400 We oversampled girls because we wanted to get enough girls to be able to look at them separately and we oversampled younger kids. 127 00:16:29,300 --> 00:16:38,840 For those of you who are statistically minded, we then adjusted all these statistics back to the true proportions of the detention centre. 128 00:16:39,050 --> 00:16:43,520 And Cook County, by the way, is very similar to most detention centres around the country, 129 00:16:43,850 --> 00:16:50,990 which is that they are mostly male, mostly racial and ethnic minorities, and especially African-Americans. 130 00:16:52,580 --> 00:16:57,860 This slide shows the demographic characteristics of our sample. 131 00:16:59,480 --> 00:17:05,000 And what you'll see is that we had about a thousand African-Americans, about 500 Hispanics, 132 00:17:05,420 --> 00:17:11,720 about 300 non-Hispanic whites, and about four of other race or ethnicity. 133 00:17:12,650 --> 00:17:17,990 We have the largest sample of delinquent girls ever collected, about 650. 134 00:17:18,860 --> 00:17:25,640 The others, about 1200 are males. The average age mean median was just under 15. 135 00:17:26,390 --> 00:17:29,480 And you'll notice we have something here called legal status. 136 00:17:29,900 --> 00:17:40,190 And that's because in the U.S., we have this unusual situation where the state legislature, you know, Colorado, 137 00:17:40,190 --> 00:17:50,300 New York, Illinois can automatically decide that some crimes are so serious that they merit transfer to adult court. 138 00:17:50,450 --> 00:17:54,260 So they bypass juvenile court, they go to regular adult court. 139 00:17:55,580 --> 00:18:03,890 So because we wanted to get those kids as well, we oversampled kids that were processed in adult court. 140 00:18:04,760 --> 00:18:07,249 As an aside, by the way, you'll be very interested in this. 141 00:18:07,250 --> 00:18:17,900 As a criminologist, one would think that the offences that would result in automatic transfer to adult court would be serious interpersonal violence. 142 00:18:18,230 --> 00:18:24,050 In fact, they're often things like selling a certain amount of drugs within two blocks of a school. 143 00:18:25,580 --> 00:18:28,670 It's they're not necessarily the most serious crimes. 144 00:18:28,670 --> 00:18:35,390 And it's a highly controversial policy because virtually all kids who are transferred to adult court, 145 00:18:35,600 --> 00:18:40,730 virtually all of them are African-American, which makes sense. 146 00:18:41,000 --> 00:18:47,600 Think about it. If you're going to be sent to adult court because you sent sell drugs within a certain number of blocks of a school, 147 00:18:47,990 --> 00:18:53,059 poor people who are disproportionately African-American are more likely to live in densely 148 00:18:53,060 --> 00:18:58,250 populated areas where you could be on the street anywhere and be fairly near a school. 149 00:18:59,870 --> 00:19:03,030 So we took this random sample of kids. 150 00:19:03,080 --> 00:19:09,770 The bottom shows you the age distribution. We had a terrific participation rate. 151 00:19:10,160 --> 00:19:16,580 So many people thought we couldn't do this study. They thought that you'll never get these kids to agree. 152 00:19:17,750 --> 00:19:20,750 And in fact, and we did pay the kids. 153 00:19:20,750 --> 00:19:25,610 We paid them $15 for the interview initially and $10 for a urine sample. 154 00:19:26,510 --> 00:19:31,640 At that, we tested for drugs and almost no one said no. 155 00:19:32,060 --> 00:19:35,570 Our refusal rate from the kids was 1.8%. 156 00:19:36,380 --> 00:19:42,980 Our refusal rate from their caretakers was a little higher, 3.8%. 157 00:19:43,580 --> 00:19:46,879 And by the way, we had a special dispensation. 158 00:19:46,880 --> 00:19:51,200 If we couldn't find the caretakers, we were able to skip that step. 159 00:19:51,320 --> 00:19:58,940 But that required that's a very long process. We had special permission from that that we received from the Institutional Review Board. 160 00:20:00,560 --> 00:20:06,440 But we had terrific cooperation because for so many of these kids, nobody had ever talked to them. 161 00:20:07,040 --> 00:20:14,060 And for many of them, when we would make arrangements to pay them, they would say, You don't have to pay me. 162 00:20:14,570 --> 00:20:18,260 It's enough. You talk to me. It's enough. You listened to me. 163 00:20:18,800 --> 00:20:27,770 So these were kids aged 10 to 17, who many of whom had never really had an adult, spend time talking to them. 164 00:20:28,310 --> 00:20:33,800 So these kids are, you know, really in fairly, fairly difficult straits. 165 00:20:34,310 --> 00:20:42,320 I also want to mention the enormous social class bias in the U.S., which I think is a bit different than here we spent. 166 00:20:42,480 --> 00:20:51,450 Two and a half years collecting, amassing our subject pool two and a half years down at the detention centre. 167 00:20:52,290 --> 00:20:56,310 In two and a half years, we never had a kid from the wealthy North Shore. 168 00:20:56,970 --> 00:21:05,850 Never. The wealthy North Shore is the part of the Chicago suburbs where it's not even wealthy, wealthy people. 169 00:21:05,850 --> 00:21:11,250 It's even upper middle class enough. We never had a kid from the wealthy North Shore. 170 00:21:11,340 --> 00:21:21,150 Never. Now, I do not believe that kids who go to those high schools never use drugs, never sell drugs, never get into fights. 171 00:21:21,630 --> 00:21:25,800 But it's a completely different situation for these poor our kids, 172 00:21:26,100 --> 00:21:34,680 because when a kid from a wealthier school gets into trouble, they're the principal is more likely to try to call the parent. 173 00:21:34,950 --> 00:21:39,660 The parent is probably not working on a factory floor and can reach the phone. 174 00:21:40,110 --> 00:21:47,160 The parent is more likely to be savvy and knowledgeable and get down to the school right away even. 175 00:21:47,520 --> 00:21:52,470 And if even if the principal decides that it should result in a formal disposition, 176 00:21:52,860 --> 00:21:58,110 the parent will get down to the local lockup and try to negotiate, release. 177 00:21:58,110 --> 00:22:06,900 And if not, that parent will probably be savvy enough to have the family lawyer come down and that kid never spent a night in a lock up 178 00:22:07,500 --> 00:22:19,290 and that our sample and how impoverished they are and the lack of anyone with resources indicates to me that in the U.S., 179 00:22:19,620 --> 00:22:23,280 the juvenile justice system especially is a system for the poor. 180 00:22:23,580 --> 00:22:27,570 It's not a system for kids with problems who have resources. 181 00:22:29,340 --> 00:22:35,670 So we sampled them at intake and then we followed them up wherever they were when their interview was due. 182 00:22:36,120 --> 00:22:40,350 So remember I mentioned that all the large scale general population studies, 183 00:22:40,590 --> 00:22:47,340 when a participant speak, when a subject becomes incarcerated, they're gone, they're just lost. 184 00:22:47,340 --> 00:22:51,150 To follow up, we did something completely different. 185 00:22:51,300 --> 00:22:56,700 We re-interviewed our subjects regardless of where they lived when their interview was due, 186 00:22:57,510 --> 00:23:02,229 if they were in detention, still underage and in detention, we went there. 187 00:23:02,230 --> 00:23:07,020 If they were in Cook County jail, we went there. If their they were in an Illinois prison downstate. 188 00:23:07,350 --> 00:23:13,500 We went there if they were at home in Cabrini-Green, a notorious housing project, 189 00:23:13,890 --> 00:23:23,670 a project my interviewers trekked up six flights of urine, urine smelling hallways to get to that participant. 190 00:23:23,910 --> 00:23:33,389 So we went wherever they were. As a consequence, our follow up rate, our loss rate is extremely low and the participation rate at all, 191 00:23:33,390 --> 00:23:38,730 the follow ups is between 84 and 97%, very high rate. 192 00:23:39,240 --> 00:23:49,740 We also implemented state of the art techniques, which is another lecture entirely because we have a complicated computerised system based on Oracle. 193 00:23:50,310 --> 00:23:54,270 So the same kind of system where you call your credit card company and they 194 00:23:54,270 --> 00:23:58,200 know that you bought a lamp for your Aunt Sadie in Manhattan two weeks ago. 195 00:23:58,200 --> 00:24:02,730 That's the kind of system we use so that we know that the last time we talked to you, 196 00:24:03,000 --> 00:24:07,500 you were living at your friend's mother and the time before you were living with your mother's friend. 197 00:24:07,830 --> 00:24:16,080 And so we keep a great deal of detailed information so that when we do lose a subject, we can literally hit the streets to find them again. 198 00:24:17,370 --> 00:24:25,229 We also had agreements with Illinois Department of Corrections, most prisons within a couple of hours, 199 00:24:25,230 --> 00:24:33,510 drive of Chicago, Cook County Jail, the detention centre to be able to go in and interview our participants. 200 00:24:34,020 --> 00:24:38,610 That took a lot of lunches. Clearly, this is not Chicago. 201 00:24:38,610 --> 00:24:44,130 No one laughed at that joke. It actually did take lunches. 202 00:24:49,050 --> 00:24:58,560 So this recaps what I just mentioned the stratified random sample over sampling certain groups and tracking and re-interviewing them. 203 00:24:58,860 --> 00:25:08,160 And we have been tracking and re-interviewing them since they were enrolled, which was between late 1995 and 1998. 204 00:25:12,640 --> 00:25:15,670 I'm going to focus a great deal on psychiatric disorders. 205 00:25:16,300 --> 00:25:20,590 So I just wanted to give you a list of the disorders that we studied. 206 00:25:21,070 --> 00:25:23,400 So there are two categories. 207 00:25:23,410 --> 00:25:33,070 If you are in, you know this, but there are two categories of disorders, what are called internalising disorders, externalising disorders. 208 00:25:33,310 --> 00:25:43,120 And so we looked at Depression Dysthymia, which is a more chronic form of depression, but sometimes milder manic episode. 209 00:25:43,120 --> 00:25:46,120 Hypomania, anxiety disorders. 210 00:25:46,660 --> 00:25:51,430 Conduct disorder when they were young. Oppositional defiant disorder also. 211 00:25:51,430 --> 00:25:58,569 Which is a disorder when they're young. Antisocial personality disorder, which is a disorder that people have when they're old. 212 00:25:58,570 --> 00:26:02,470 You have to be over age 18 to have that disorder. 213 00:26:02,950 --> 00:26:06,820 And then, of course, substance use disorders, alcohol and drug. 214 00:26:11,140 --> 00:26:16,340 So let's look at some of the findings. How am I doing on time? 215 00:26:17,150 --> 00:26:33,330 It's definitely tough. Great. So this graph, this show, this bar chart shows the prevalence of disorders at the baseline interview. 216 00:26:33,450 --> 00:26:38,220 By the way, the baseline interview took about 3 hours at sometimes two. 217 00:26:38,640 --> 00:26:49,560 And we conducted that interview in a private room that the kids were that they used to have the youth meet with their lawyers. 218 00:26:49,890 --> 00:26:56,760 So it was in a private area. And we have confidence in the quality of the data collected in those interviews. 219 00:26:57,240 --> 00:27:00,810 We also use very skilled interviewers. 220 00:27:00,930 --> 00:27:10,260 We use people with a master's degree, and they also had to have had experience studying what are called high risk populations. 221 00:27:10,560 --> 00:27:14,340 So if you had only worked in a clinic with white people, we weren't interested in you. 222 00:27:14,820 --> 00:27:21,060 So we had outstanding interviewers who knew how to work with this difficult population. 223 00:27:23,070 --> 00:27:29,790 So I want to highlight here the bottom part, which is that about three quarters of the girls and by the way, 224 00:27:30,000 --> 00:27:34,530 usually my convention is to have pink for females and to have blue for boys. 225 00:27:34,550 --> 00:27:41,340 I stereotypical but if I can keep it in mind but we see that about three quarters of the girls 226 00:27:41,340 --> 00:27:50,250 and about two thirds of the boys have one or more of the disorders listed in this chart, 227 00:27:50,760 --> 00:28:00,510 one or more. And we also see that the most common disorder was substance use disorder. 228 00:28:01,290 --> 00:28:08,670 And by that, let me explain. That's not substance use, but rather it's abuse or dependence. 229 00:28:09,450 --> 00:28:13,890 To qualify for substance use disorder is actually pretty difficult. 230 00:28:14,160 --> 00:28:22,139 You have to have had a certain number of symptoms of a certain severity that interrupt your the patterns 231 00:28:22,140 --> 00:28:30,120 of your life in a certain way so that it's not merely use substance use disorders are serious illnesses. 232 00:28:30,780 --> 00:28:40,230 And so we see that about half of the boys and and just under half of the girls had one or more substance use disorders. 233 00:28:40,500 --> 00:28:43,830 And this was at the baseline interview when they were aged 10 to 17. 234 00:28:49,440 --> 00:28:54,390 This shows racial and ethnic differences among the boys. 235 00:28:55,110 --> 00:29:06,000 And so we compare the non-Hispanic whites, the lightest blue to Hispanics, the median blue to the darkest blue, which is African-American. 236 00:29:06,780 --> 00:29:16,440 And we have some, you know, kind of interesting patterns here where we see for some disorders, the highest rates are among the non-Hispanic whites. 237 00:29:17,490 --> 00:29:19,559 And we find that very depressing. 238 00:29:19,560 --> 00:29:29,190 And we believe that's because the bar is much lower for African-Americans to enter the system than for non-Hispanic whites. 239 00:29:29,520 --> 00:29:34,290 So to be a white kid and get arrested, basically, you have to be a pretty screwed up kid. 240 00:29:34,920 --> 00:29:42,390 And we have found this difference, by the way, this racial and ethnic difference in all of our studies of incarcerated populations. 241 00:29:42,660 --> 00:29:46,500 We found it in our Women in Jail study. We found it in our men in jail study. 242 00:29:47,340 --> 00:29:55,230 Typically, the folks in the system who are non-Hispanic white are in much worse shape than the African-Americans. 243 00:29:59,710 --> 00:30:06,070 Here we look at racial and racial and ethnic differences among the girls in the sample. 244 00:30:06,190 --> 00:30:10,600 Can everyone see this reasonably sorry. 245 00:30:10,990 --> 00:30:15,370 My nightmare always is. The screen is going to be that big and no one will be able to see the slides. 246 00:30:17,560 --> 00:30:24,639 So here also we see that it's for many disorders. 247 00:30:24,640 --> 00:30:34,660 It's the non-Hispanic white kids that have significantly higher rates of psychiatric disorders than the African-American kids. 248 00:30:35,170 --> 00:30:39,670 And it's interesting that that's the same for males and it's similar for females. 249 00:30:46,390 --> 00:30:51,160 This is a chart. When I present this to. Do you guys know Venn diagrams? 250 00:30:52,150 --> 00:30:55,930 Yes. Great. Okay. I present this to judges and they groan. 251 00:30:58,060 --> 00:31:09,850 But it's actually a terrific way to show the prevalence of co-morbid disorders, meaning the prevalence of people who have more than one disorder. 252 00:31:10,330 --> 00:31:16,330 You know, as you know, you're not necessarily you don't necessarily have only depression or only an addiction. 253 00:31:16,330 --> 00:31:21,430 You can have both. So what this shows is the overlap of disorders. 254 00:31:21,940 --> 00:31:27,940 This is data from the baseline interview and you can't see the numbers here. 255 00:31:27,940 --> 00:31:32,170 They're just too small. We have I have a there is an article where these are published in. 256 00:31:34,940 --> 00:31:41,090 It's now called JAMA Psychiatry. It was part of the archives, archives of General Psychiatry. 257 00:31:41,360 --> 00:31:44,060 And so we have these published, if you're interested in the numbers. 258 00:31:44,300 --> 00:31:51,800 But what I want you to focus on is the size of the overlap, where this is a very bad news chart. 259 00:31:52,280 --> 00:31:57,799 A good news chart would mean that you had less overlap because it's easier to 260 00:31:57,800 --> 00:32:02,390 treat people if they have only one disorder than if they have two or three. 261 00:32:03,380 --> 00:32:08,300 And so this is a very bad news chart because of the degree of overlap. 262 00:32:09,500 --> 00:32:14,540 So this chart shows the prevalence of comorbid disorders among males. 263 00:32:18,450 --> 00:32:25,050 And this shows the prevalence of co-morbid disorders, meaning having more than one among females. 264 00:32:26,040 --> 00:32:37,349 And what you see is that the patterns are different, but both males and females are depressingly similar in that comorbid disorders, 265 00:32:37,350 --> 00:32:46,950 meaning having more than one is almost the rule and not the exception, which does not bode well for treatment for successful treatment. 266 00:32:51,820 --> 00:33:03,580 Substance use disorders also can be co-morbid because you may have an alcohol use disorder and a marijuana use disorder or an other drug use disorder, 267 00:33:03,580 --> 00:33:05,470 you know, cocaine, heroin, whatever. 268 00:33:06,010 --> 00:33:16,270 And what we see is that especially for kids with alcohol use disorder, many of them also had another substance use disorder as well. 269 00:33:19,290 --> 00:33:26,430 This is also published. For any of you, if you want, I can send you a bibliography if you want, or even the articles if you wish. 270 00:33:27,240 --> 00:33:33,930 Some of what I'm showing is brand new and in press or even in process, and other things are published. 271 00:33:34,620 --> 00:33:40,410 So this shows the amount of comorbid substance use disorders among males. 272 00:33:44,570 --> 00:33:54,740 And this shows the overlap co-morbid of comorbid substance use disorders among females. 273 00:33:59,850 --> 00:34:07,319 I think what's interesting about this is that we've done the kind of work so often where people say, 274 00:34:07,320 --> 00:34:12,120 well, we already know that, and then you look and there's no study, so we don't know it. 275 00:34:12,120 --> 00:34:19,950 It's all based on presumption here. We know it and we can allocate the resources we need to treat these kids. 276 00:34:20,940 --> 00:34:26,790 This is a very depressing chart because the part this is a chart of IQ. 277 00:34:29,190 --> 00:34:42,510 We did a pretty rudimentary test of intelligence and we found that there were so few above average that you can't even see. 278 00:34:43,260 --> 00:34:50,730 It's like way at the top, you can hardly even see it. And what we found, and I think because of the light, you may have difficulty seeing it, 279 00:34:51,060 --> 00:34:56,460 that more than three quarters were below average, three quarters. 280 00:34:58,470 --> 00:35:05,690 So these kids do not have a lot of resources. This is from a recent article. 281 00:35:05,690 --> 00:35:09,800 And here we're looking at changes in disorders over time. 282 00:35:11,420 --> 00:35:14,240 And we look here at the baseline interview, 283 00:35:14,660 --> 00:35:20,780 the first interview we had and then what we call here the time one interview which occurred about three years later, 284 00:35:21,380 --> 00:35:25,040 and then the time to interview, which occurred about five years later. 285 00:35:26,030 --> 00:35:29,390 And there's a lot of very interesting patterns here. 286 00:35:30,320 --> 00:35:35,630 The blue dotted lines are males, the solid pink lines are females. 287 00:35:37,100 --> 00:35:49,670 So what we see here is that the girls, for example, with major mood, they start much higher than the boys, but they really plummet. 288 00:35:50,120 --> 00:35:54,830 And so there's still differences five years later, but the differences are far less. 289 00:35:56,240 --> 00:36:00,260 And we see something that that's very similar with anxiety disorders, 290 00:36:00,260 --> 00:36:05,030 where initially their rates are so much higher than the boys and then the girls plummet. 291 00:36:05,030 --> 00:36:12,470 And this is something that we'll see again and again here. And I want to state now what what the overall finding is, 292 00:36:12,830 --> 00:36:20,360 which is that the girls get better do better than boys, which is not something that we would have anticipated. 293 00:36:23,820 --> 00:36:29,730 We see similar patterns with substance use disorders and disruptive behaviour disorders. 294 00:36:29,940 --> 00:36:37,829 Disruptive behaviour disorders means conduct disorders or ADHD or when they're older, 295 00:36:37,830 --> 00:36:41,610 antisocial personality disorder, they're are they all have to do with behaviour. 296 00:36:42,270 --> 00:36:53,130 And so what we see here is that the girls just that the girls rates just plummet compared to the boys 297 00:36:54,660 --> 00:37:03,600 they're not different at the baseline dropped quite a bit three years later and dropped even more later, 298 00:37:03,990 --> 00:37:12,450 five years later. And so and we see that this is the pattern with African-American females, Hispanic females, non-Hispanic white females. 299 00:37:12,960 --> 00:37:21,240 So it's a very interesting finding because we had anticipated that the girls would do much worse than the boys. 300 00:37:21,240 --> 00:37:28,709 We just thought that because there have been a number of articles written with tiny samples talking impressionistic about, 301 00:37:28,710 --> 00:37:32,370 you know, the girls did so badly, they got pregnant, they did this, this happened. 302 00:37:32,370 --> 00:37:36,029 They had pimps that abuse them. 303 00:37:36,030 --> 00:37:43,500 They were addicted. And so we thought that our the girls in our sample were just going to be in dreadful shape. 304 00:37:43,800 --> 00:37:57,720 And in fact, they did better than the boys. More Venn diagrams, and this one looks at co-morbid disorder over time. 305 00:37:58,680 --> 00:38:08,370 This is a very interesting chart because what you'll see is that the level of comorbid disorders, meaning overlapping disorders, 306 00:38:08,700 --> 00:38:13,529 goes down over time because look how big the circles are at baseline and they're 307 00:38:13,530 --> 00:38:19,740 smaller at three years later and they're even a little bit smaller five years later. 308 00:38:20,250 --> 00:38:25,410 And so what happens is that disorders are going down, but co-morbid disorders are also dropping. 309 00:38:25,920 --> 00:38:34,190 That's the case for the boys. And that's also the case for the girls. 310 00:38:43,620 --> 00:38:52,170 I like to show this chart because it contradicts what we expect of delinquent kids. 311 00:38:53,700 --> 00:38:58,050 So this shows the prevalence rates of substance use disorders. 312 00:38:58,530 --> 00:39:02,910 From the baseline study up through the 12 year follow up interview. 313 00:39:04,890 --> 00:39:09,299 And remember that the information we collected wasn't from records. 314 00:39:09,300 --> 00:39:16,320 It was from face to face standardised interviews with well-trained interviewers that were the project staff. 315 00:39:17,550 --> 00:39:22,140 What I find there's a number of things I find here fascinating. 316 00:39:22,140 --> 00:39:29,740 But most interesting is that look at the rate of other drug disorders, which would be cocaine, heroin. 317 00:39:30,030 --> 00:39:34,800 In other words, a drug that's not alcohol, not marijuana. Look at it. 318 00:39:35,070 --> 00:39:42,870 It's like nothing. And we always think of these kids as being cocaine addicts and heroin addicts, and they're not. 319 00:39:43,530 --> 00:39:49,620 The rate is just so low and it starts low and it stays low. 320 00:39:50,400 --> 00:39:53,580 They don't it's it's I find this chart fascinating. 321 00:39:54,090 --> 00:40:02,790 And we also see that the most prevalent disorder, substance use disorder, rather, is not alcohol, but it's marijuana. 322 00:40:04,680 --> 00:40:05,489 For our kids, 323 00:40:05,490 --> 00:40:15,270 they told us that it was much easier for them to buy marijuana than it was for them to buy alcohol because for alcohol they were underage. 324 00:40:15,330 --> 00:40:18,570 And so that was a problem. But marijuana, that was easy. 325 00:40:19,500 --> 00:40:23,310 So this is a very interesting chart. This chart shows males. 326 00:40:26,740 --> 00:40:39,250 This chart shows females and we see the same kind of pattern where the most prevalent disorder at baseline is marijuana and that that drops greatly, 327 00:40:39,250 --> 00:40:42,610 which is very good news that it dropped so much. 328 00:40:43,180 --> 00:40:46,630 But again, what's most shocking is other drug. 329 00:40:47,530 --> 00:40:52,660 It's so uncommon at all of the interviews. 330 00:40:52,840 --> 00:40:56,920 It's, you know, 5%, 6% for it's nothing, absolutely nothing, 331 00:40:57,160 --> 00:41:02,860 completely contradicting what one's expectations would be about kids in the juvenile justice system. 332 00:41:07,650 --> 00:41:13,920 This is a chart looking at racial and ethnic differences, and this is males. 333 00:41:14,910 --> 00:41:22,170 This is a also a very depressing chart, given what we know about disproportionate incarceration of African-Americans, 334 00:41:22,980 --> 00:41:28,350 given that African-Americans are disproportionately incarcerated, especially for drug crimes. 335 00:41:29,190 --> 00:41:41,130 You would expect that African-Americans would have much higher prevalence rates of cocaine use disorders, heroin use disorders. 336 00:41:41,220 --> 00:41:47,820 You know, the really bad drugs, that's what you would anticipate. But look at the rate for African-Americans, the dark blue line. 337 00:41:48,090 --> 00:41:57,780 Look at that rate and compare that rate to that of the non-Hispanic white males, which is about 20% at baseline. 338 00:41:58,140 --> 00:42:03,150 And then it's still about 15% at the 12 year follow up interview. 339 00:42:03,630 --> 00:42:04,710 So think about that, 340 00:42:04,920 --> 00:42:17,490 that all of these African-Americans are incarcerated for drug crimes and yet they do not abuse the most serious types of subcategories of drugs. 341 00:42:20,580 --> 00:42:26,850 So that's the chart for the males. And we see that it's the same thing for females. 342 00:42:27,540 --> 00:42:35,100 Now with females, the rates among the girls drop a great deal because I mentioned that girls tend to do better than boys pretty much in every way. 343 00:42:42,890 --> 00:42:46,670 That's not a very good chart, huh? All right. 344 00:42:47,090 --> 00:42:52,700 So what this looks at is life time, substance use disorders, 345 00:42:53,000 --> 00:43:02,270 meaning did what proportion of these kids had a substance use disorder at some point in their lifetime? 346 00:43:02,600 --> 00:43:08,720 At the 12 year follow up interview. So at the 12 year follow up interview, they would have been, you know, late twenties, early thirties. 347 00:43:09,410 --> 00:43:20,990 And it's astonishing. I found this shows the top part shows males, the bottom part shows females. 348 00:43:21,560 --> 00:43:31,100 And what we see is that the prevalence rates for most of these subgroups, the lifetime rates are simply so high. 349 00:43:31,310 --> 00:43:37,280 Let's take a look, for example, at the first part, which is any substance use disorder, alcohol or any drugs. 350 00:43:38,000 --> 00:43:43,460 And what we see is that it's about 90% of the white females. 351 00:43:43,670 --> 00:43:49,460 It's about close to 90% of the non-Hispanic white males. 352 00:43:49,700 --> 00:43:57,050 Just incredible rate. And so we see that addictions are one of the most serious problems that these kids have. 353 00:43:59,780 --> 00:44:05,719 This is one of, I think, the most fascinating charts. And again, this is not use it's addiction. 354 00:44:05,720 --> 00:44:09,440 Yes. What was to classify as a substance use disorder again. 355 00:44:09,650 --> 00:44:13,970 But it wasn't just you know, it's not use it's called a substance use disorder. 356 00:44:14,150 --> 00:44:20,389 But in fact, the it's it's hard to get that diagnosis because it means you have to have a 357 00:44:20,390 --> 00:44:26,090 certain number of symptoms over a certain period of time of a certain severity. 358 00:44:26,750 --> 00:44:30,350 And so DSM would do a much better job of explaining it than I did. 359 00:44:30,350 --> 00:44:39,049 And the diagnoses, by the way. They're not made in an ad hoc way, so they're not that the interview just talks to the kid and says, 360 00:44:39,050 --> 00:44:42,350 Oh, yeah, you have trouble with school and do you smoke marijuana? 361 00:44:42,590 --> 00:44:45,050 It's not it is not casual. It is. 362 00:44:45,200 --> 00:44:57,100 Our interviews are what are called structured psychiatric interviews, where we use assessments that have been proven to be reliable and valid. 363 00:44:57,110 --> 00:45:00,230 We then have our own validity check in our own study. 364 00:45:00,500 --> 00:45:10,729 So we used the diagnostic interview schedule for children at the baseline, and then we changed the assessments as the kids aged. 365 00:45:10,730 --> 00:45:15,380 Because you can't use the same questions with a ten year old that you would use with a 20 year old. 366 00:45:15,920 --> 00:45:22,400 And we use things like the like the skid, like what's called the CD, CDI. 367 00:45:22,520 --> 00:45:24,530 I can give you more information if you're interested. 368 00:45:24,800 --> 00:45:33,410 But the important part here is that these disorders are diagnosed in a way that is consensually understood, 369 00:45:34,280 --> 00:45:41,060 established, therefore have construct validity and are assessed in a systematic way. 370 00:45:41,510 --> 00:45:52,069 And so what I find frightening here is the really the horrific rate we have of lifetime substance use disorders up to the late twenties, 371 00:45:52,070 --> 00:45:58,730 early thirties. This is a complicated chart. 372 00:45:58,750 --> 00:46:03,879 I have I have four of them. And I couldn't figure out whether I should show them or not. 373 00:46:03,880 --> 00:46:12,820 But I find them very, very interesting and I realise that Oxford has small screens, so it was probably not a good choice. 374 00:46:14,320 --> 00:46:24,040 But this slide shows among kids who had a substance use disorder or not at the baseline, 375 00:46:24,730 --> 00:46:30,160 what proportion of them had a substance use disorder five years later? 376 00:46:30,880 --> 00:46:35,740 And what's interesting about this is that we always think of kids in terms of progression. 377 00:46:36,040 --> 00:46:42,820 You know, they start with alcohol, then they progressed to marijuana, then they progressed to cocaine, then they progressed to heroin. 378 00:46:43,000 --> 00:46:48,100 And so we were really interested in seeing, in fact, was that true? 379 00:46:48,310 --> 00:47:02,200 Which we could do is show that the rows here represent the kids, but the prevalence of kids at Baseline who had no disorders, that's the bottom line. 380 00:47:02,740 --> 00:47:06,639 Alcohol disorders, that's the second marijuana use disorders. 381 00:47:06,640 --> 00:47:10,879 That's the third alcohol and marijuana use disorders. 382 00:47:10,880 --> 00:47:13,930 That's the fourth and then other at the fifth. 383 00:47:14,500 --> 00:47:21,640 And then what the bars show is what proportion of them had a disorder at the follow up. 384 00:47:23,140 --> 00:47:33,250 And so what we see, we see something in the expected direction, which is that among those kids who had no substance use disorder at baseline, 385 00:47:33,430 --> 00:47:38,530 about three quarters of them still did not have a substance use disorder at the follow up. 386 00:47:38,950 --> 00:47:40,690 In other words, they did not develop one. 387 00:47:41,830 --> 00:47:50,559 And in contrast, what we see, if we look at the top line among kids who had an other drug use disorder, meaning cocaine, 388 00:47:50,560 --> 00:48:01,840 heroin at the follow up, five years later, about 18% of them still had one of those substance use disorders. 389 00:48:03,040 --> 00:48:05,200 So it's a very interesting kind of chart, 390 00:48:05,410 --> 00:48:12,340 and I think I'm going to skip over the others because I think this room is too small for me to do these justice. 391 00:48:12,550 --> 00:48:18,040 And given it's late afternoon and we have alcohol to look forward to, I don't want everyone to fall asleep. 392 00:48:18,880 --> 00:48:24,100 I can say that because I'm an alcohol researcher, I a user. 393 00:48:26,980 --> 00:48:29,799 So let's look at positive outcomes. How are we on time, by the way? 394 00:48:29,800 --> 00:48:34,990 And I'm in a very good job of this as long as we're out of this room by ten to just 20 minutes from now. 395 00:48:34,990 --> 00:48:44,260 Seven at a time. Okay. No question. Okay, great. So we looked at positive outcomes, which we could do because we had a sample of kids. 396 00:48:44,680 --> 00:48:48,190 And so first, I'm going to show you positive outcomes five years later. 397 00:48:48,190 --> 00:48:55,300 And we looked at educational attainment, employment assistance from criminal activity, non-violent personal relationships. 398 00:48:55,780 --> 00:49:04,940 Residential stability. Psychological well-being. Just re incarceration five years later. 399 00:49:04,960 --> 00:49:12,220 Very depressing. 93% of African-American males were re incarcerated one or more times. 400 00:49:12,820 --> 00:49:16,750 The lowest rate was among non-Hispanic white males, about 40%. 401 00:49:23,740 --> 00:49:29,410 We also looked at this. We just set a date May two, 2012. 402 00:49:30,130 --> 00:49:35,920 And again, the incarceration rate is astonishing given how young these kids were when we sampled them. 403 00:49:36,220 --> 00:49:44,560 So nearly all of the African-American males were incarcerated one or more times by May 2012. 404 00:49:50,470 --> 00:49:54,430 Outcomes. We see that they don't do terrific. 405 00:49:55,780 --> 00:49:58,930 They don't psychological well-being. 406 00:49:59,110 --> 00:50:01,960 We have we have by the way, we have very low bars on this. 407 00:50:02,380 --> 00:50:13,480 So that criminal assistance we originally said we defined assistance as not having been arrested or any crime. 408 00:50:14,140 --> 00:50:19,140 And then we had to drop it to any violent crime because everybody fell out of the sample. 409 00:50:22,210 --> 00:50:32,560 Looking at all of those criteria that I mentioned, we found that only 9% of the sample were doing well on all those criteria. 410 00:50:32,800 --> 00:50:43,030 9%. This is information on positive outcomes 12 years after detention. 411 00:50:44,200 --> 00:50:51,670 And again, we'll be working on a paper on this. These data are probably best viewed in the context of that paper. 412 00:50:52,120 --> 00:50:56,590 But what we see is that they do not do very well. 413 00:50:57,430 --> 00:51:03,330 And this is 12 years later. The girls, by the way, do better than the males. 414 00:51:07,620 --> 00:51:14,700 And also the non-Hispanic whites do much better than the African-Americans, even though, as you recall, 415 00:51:15,120 --> 00:51:20,700 the non-Hispanic white kids had much higher rates of substance use disorders like cocaine, heroin, etc. 416 00:51:31,490 --> 00:51:34,910 You can't read this chart in the back. You can probably barely read this chart. 417 00:51:35,120 --> 00:51:41,750 Yeah, this chart lists all of our deaths since the study started. 418 00:51:43,010 --> 00:51:47,780 Eight out of 829 kids, 122 have died. 419 00:51:48,410 --> 00:51:55,430 And this chart lists in tiny print because we kept having to reduce the font as more and more kids died. 420 00:51:57,740 --> 00:52:02,630 This was the cause of death the age, gender and race and ethnicity. 421 00:52:02,930 --> 00:52:10,310 Interestingly, most studies report deaths in one sentence in a method section. 422 00:52:11,060 --> 00:52:20,060 We had so many deaths after six years that we published an entire paper just on our death rate in the medical journal Paediatrics. 423 00:52:21,230 --> 00:52:26,390 And our second paper, again on Death, will be published in Paediatrics in July. 424 00:52:27,080 --> 00:52:32,239 Papers on Death Rates. Who would think you could write papers on death rates among 1800 kids? 425 00:52:32,240 --> 00:52:39,450 Who would think you would have the sample size? But we did have the sample size. 426 00:52:39,780 --> 00:52:52,890 So this is one of the charts that'll be in the paper and paediatrics and it shows the causes of death among males and females in our sample. 427 00:52:53,760 --> 00:53:03,420 And so what we see is that close to 90% of the boys died from homicide with a firearm, but 90%. 428 00:53:13,370 --> 00:53:20,750 This compares our sample to the general population and we adjusted the general population for demographic differences. 429 00:53:21,350 --> 00:53:23,300 So we weren't comparing apples and oranges. 430 00:53:24,080 --> 00:53:33,860 And so what we see is that our rate of homicide among males is close to three times higher than that in the general population. 431 00:53:34,010 --> 00:53:37,850 Chicago is a dangerous city, so we have a high homicide rate. But even so. 432 00:53:43,000 --> 00:53:55,629 And we see a similar situation for girls. Homicide in the general population is 14% and homicide in our sample was 28% with a 433 00:53:55,630 --> 00:54:01,480 firearm and 13% of other one girl was knifed to death by her boyfriend in the kitchen. 434 00:54:01,480 --> 00:54:06,620 Another girl was run over by her boyfriend because she went out with someone else. 435 00:54:06,640 --> 00:54:15,810 It's very common. I just clarify. So so those examples would come under the other because I was thinking your other homicide, other homicide. 436 00:54:15,910 --> 00:54:19,930 So the other is death through illness, cancer, whatever. 437 00:54:19,940 --> 00:54:27,540 Yes, yes. Okay. Yes. Which we had very few. So in your delinquent male population, almost no threat of what you might call sort of no normal illness? 438 00:54:27,550 --> 00:54:32,620 No, no, it doesn't happen. They don't live long enough to die from illness. 439 00:54:32,620 --> 00:54:38,260 No. So we have we also looked at risk factors because ironically, 440 00:54:38,890 --> 00:54:43,450 there were so many deaths since our last paper that we could actually look at risk factors. 441 00:54:43,930 --> 00:54:50,500 And we found that three variables assessed in adolescence predicted early violent death. 442 00:54:51,460 --> 00:54:55,840 And that was alcohol use disorder, by the way, not drug use disorder. 443 00:54:55,960 --> 00:54:59,080 And that makes sense because drugs usually make you pretty calm. 444 00:54:59,140 --> 00:55:02,260 Most drugs, alcohol doesn't make you such a nice person. 445 00:55:03,130 --> 00:55:14,350 So alcohol use disorder was a significant predictor of early violent death, as was being involved in the drug economy. 446 00:55:14,710 --> 00:55:21,280 And these are factors measured in adolescence, but they were still risk factors for people in their late twenties. 447 00:55:22,720 --> 00:55:26,320 And then the last significant risk factor was gang membership. 448 00:55:26,980 --> 00:55:34,240 And again, gang membership early on predicting early predicting violent death when you're in your late twenties. 449 00:55:37,210 --> 00:55:46,090 What I'd like to do now is just talk a little bit about future directions for research and then open it up to questions. 450 00:55:48,190 --> 00:55:54,190 One area that I'm very interested in are the consequences of incarceration. 451 00:55:56,080 --> 00:56:01,480 Many studies examined recidivism and among people who have been incarcerated, 452 00:56:02,320 --> 00:56:08,770 and then many people actually examine health among currently incarcerated populations. 453 00:56:09,280 --> 00:56:19,239 But no study that I've ever found examines how patterns of incarceration affect health and being a professor in a medical school. 454 00:56:19,240 --> 00:56:28,240 I am interested in health and so think about all of the variables we have age of incarceration, the number of incarcerations and releases, 455 00:56:28,840 --> 00:56:37,030 length of incarceration, the amount of time you spend in the community and between incarcerations. 456 00:56:37,690 --> 00:56:42,100 Terms of release your experiences with probation, parole. 457 00:56:42,430 --> 00:56:49,810 We have all these variables and we have no information how those experiences affect health in adulthood. 458 00:56:52,300 --> 00:57:02,650 The second question I'm really interested in is re-entry and what variables improve the likelihood of successful re-entry because these kids, 459 00:57:02,830 --> 00:57:08,920 they re-enter all the time. The initial length of stay for detained kids is only a couple of weeks. 460 00:57:10,270 --> 00:57:19,150 So what we need to do is figure out how to improve short term outcomes as well as improved long term outcomes, 461 00:57:19,330 --> 00:57:23,560 and especially for minorities, because they're the ones who are having the most difficult time. 462 00:57:26,330 --> 00:57:37,489 When people ask what I want to do in the future, I would like to get funding to study the offspring of our participants because 463 00:57:37,490 --> 00:57:42,830 most of them now have kids and we have compiled a database on their offspring. 464 00:57:43,100 --> 00:57:50,750 And it's an opportunity for us to look at the intergenerational transmission of alcohol by alcohol abuse, drug abuse and violence. 465 00:57:53,180 --> 00:57:59,780 In closing, because I do want to leave some time for questions. Unfortunately, I have five more pages of notes, but which breaks my heart. 466 00:57:59,780 --> 00:58:04,400 But I will skip it because my whole public policy section. 467 00:58:04,610 --> 00:58:11,360 But I just want to say that it's we have had health care reform. 468 00:58:12,320 --> 00:58:23,900 The it's unclear whether health care reform will help people like our participants because they may just fall through the cracks. 469 00:58:23,930 --> 00:58:27,530 Many states have not increased Medicaid. You may be aware of. 470 00:58:29,120 --> 00:58:32,570 And so it may not health care reform may not help these kids. 471 00:58:32,930 --> 00:58:37,160 But even if we even if they do have insurance. 472 00:58:37,430 --> 00:58:43,640 The problem is, I don't know if the community is ready for subjects like ours because they have so many problems. 473 00:58:44,870 --> 00:58:48,830 Most have been abused or neglected. They have addictions. 474 00:58:49,190 --> 00:58:57,470 They have comorbid psychiatric disorders. They have so many risk factors that it's actually difficult to disentangle them. 475 00:58:58,070 --> 00:59:06,020 So the question I always pose is whether the community health system is ready for participants like ours. 476 00:59:07,160 --> 00:59:10,880 Questions? Depressing topic. It is very depressing. 477 00:59:11,030 --> 00:59:13,140 See, my title was not misrepresentative. 478 00:59:13,190 --> 00:59:20,510 It's very good process, Rachel, but I actually find it an uplifting topic because we're doing something about it. 479 00:59:20,870 --> 00:59:27,140 What is depressing are all of the general population studies that cost the NIH millions of dollars, 480 00:59:27,410 --> 00:59:32,540 and they never included any people that have systematically had the worst outcomes. 481 00:59:32,810 --> 00:59:39,440 That's what I find depressing. This is not depressing. We're doing something about it and it will be used to advance public policy. 482 00:59:41,510 --> 00:59:44,510 I had a methodology methodological question. 483 00:59:45,470 --> 00:59:57,680 I was curious about your decision to use face to face interviews as opposed to something like anonymous self-report questionnaires. 484 00:59:58,490 --> 01:00:04,790 And if you thought it had an impact on how forthcoming the participants were about 485 01:00:04,790 --> 01:00:11,010 potentially stigmatised issues such as substance abuse or mental health problems. 486 01:00:11,720 --> 01:00:13,040 I think that's a great question. 487 01:00:14,900 --> 01:00:21,380 The we thought long and hard about our decision and it would have been a lot cheaper to do it in the way you suggested. 488 01:00:21,590 --> 01:00:23,660 It would not have been effective for many reasons. 489 01:00:24,020 --> 01:00:33,020 One, they would have refused the questionnaire to these kids, as you recall, from the IQ side, would not have been able to fill out a questionnaire. 490 01:00:33,500 --> 01:00:37,970 They these kids live in impoverished neighbourhoods with terrible schools. 491 01:00:38,210 --> 01:00:45,290 They do not have the verbal skills to be able to complete a questionnaire, even with the interviews. 492 01:00:45,500 --> 01:00:49,880 Sometimes we have to explain a question so that they even understand it. 493 01:00:50,060 --> 01:01:00,350 So that's one part of it. The other part is that these kids seem to have no difficulty talking about their problems. 494 01:01:00,560 --> 01:01:05,930 We made it very clear to them who we were. We were not part of the judicial process. 495 01:01:06,410 --> 01:01:14,970 We had letters attesting to that fact. I do do not believe that it at all influenced it. 496 01:01:14,990 --> 01:01:20,200 And I think we would have had no sample or had very unreliable data had we done it.