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THE 1991 NCCHC HEALTH RISK SURVEY:

An Analysis of N = 1,801 Respondents from

Juvenile Correctional Facilities

George W. Knox, Ph.D.

National Gang Crime Research Center

December, 1991

TABLE OF CONTENTS

PAGE(s)

Background of the Project............................ 1 - 2

Methodology.......................................... 2 - 3

Sample Size.......................................... 3 - 3

Descriptive Statistical Findings..................... 4 - 17

Demographic Variations Among Confined Juveniles...... 18 - 20

Factors Differentiating Reports of STD's............. 20 - 29

Factors Differentiating Drug and Substance Abuse..... 29 - 45

Factors Differentiating Suicide Variables............ 45 - 53

Factors Differentiating Gang Membership.............. 53 - 58

Factors Differentiating AIDS/HIV Information......... 58 - 61

Differences Between Short and Long Term Facilities... 61 - 66

Differences By State................................. 67 - 68

Summary and Conclusions.............................. 68 - 78

Selected Bibliography................................ 79 - 85

Appendix A: Guide to the Administration of the NCCHC Health Risk Survey................. 86 - 106

Appendix B: Copy of the NCCHC Health Risk Survey..... 107 - 112

Appendix C: Technical Note on the State I.D. Variable 113 - 114

Appendix D: Guide to the Use of Appendices E-J....... 115 - 115

Appendix E: Crosstabs of all variables by Age........ 116 - 170

Appendix F: Crosstabs of all variables by Race....... 171 - 216

Appendix G: Crosstabs of all variables by Gender..... 217 - 262

Appendix H: Crosstabs of all variables by LONGSHOR

(long term vs. short term facilities)... 263 - 316

Appendix I: Crosstabs of all variables by State I.D.. 317 - 362

Appendix J: Crosstabs of all variables by all four

suicide items (13, 14, 15, and 16)...... 363 - 546

- ii -

BACKGROUND OF THE PROJECT

This national survey data was collected during the period May-June, 1991. The survey itself contains forty five forced choice questions designed to be completed by respondents inside short and long term juvenile correctional institutions. In March-April, 1991 this survey instrument was pre-tested using juvenile correctional facilities in two states with over N = 100 respondents. The pretest indicated very little item difficulty for the lowest range of reading ability.

The sample of forty four (N = 44) juvenile correctional facilities was provided by NCCHC and these facilities represented a potential sample frame of N = 2533 respondents . The superintendents of these facilities and their governing agencies were contacted by mail in April, 1991. The purpose of the NCCHC Health Risk Survey was explained, a copy of the survey instrument was provided, and their participation in the national research project was sought.

Follow-up telephone calls indicated that five of the institutions would not participate in the research. Their reasons for not participating were not based on objections to the purpose or value of the project. Rather these five agencies had recently experienced a significant fiscal crisis involving forced lay-offs of personnel and felt the time involved with the survey would be a burden on their operations.

A substantial effort was made to protect the reliability and validity of this survey research methodology. A training tape was made and provided to all institutional staff administering the survey to confined juveniles. These institutions were also provided with a comprehensive guide to the administration of the survey (Appendix A).

By July 10, 1991 a total of N = 1,801 completed surveys had been returned and processed for data analysis. This represents a slightly higher than 70 percent return rate of questionnaires for the complete sample frame of 44 institutions .

METHODOLOGY

The sampling procedure for this national survey was designed by the National Commission on Correctional Health Care (NCCHC). The institutions to be included in the sample frame were also chosen by NCCHC. As described above in the history of the project an extensive pre-test of the survey instrument was undertaken in two different states using institutions that were not in the sample frame. This pre-test was useful in identifying potential problem areas with certain questions in the survey instrument which were then dealt with in the guide to the administration of the survey (see Appendix A).

For purposes of ensuring reliability in the data collected from confined juveniles between different institutions in five different states, the guide to the administration of the survey was prepared along with a short video training tape for the same staff. The survey was completed by the confined juveniles in small groups, typically a classroom setting, using the designated staff member at the institutional site. The staff member used the survey administration guide to read the question and explain where necessary for completing the entire survey.

SAMPLE SIZE

The sample frame consisted of forty four juvenile correctional facilities which had an overall average daily population of N = 2,533 juveniles in their care. The number of survey instruments returned consisted of N = 1,801 cases, which reflects a national response rate of 71 percent. However, there was some missing data in the surveys and this accounts for the variation in the number of cases for statistical tests described below.

DESCRIPTIVE STATISTICAL FINDINGS

Presented here are the most meaningful descriptive statistics for the data collected. This provides the number of cases (N) for each item which indicates how many youths provided a response to the survey question. This also includes the frequency and percentage distribution for each of the response modes using all of the forty five variables in the survey instrument. To thoroughly acquaint the reader of this technical report with the survey it is therefore useful to provide the question number in the survey and list the entire question in quotation marks, followed underneath by the frequency and percentage distribution.

Question number one, "HOW OLD ARE YOU?"

N %

***** *****

12 years old or younger 24 1.3

13 years old 69 3.8

14 years old 185 10.3

15 years old 387 21.6

16 years old 573 31.9

17 years old 463 25.8

18 years old or older 94 5.2

**** *****

TOTAL 1795 100.0

Question number two, "ARE YOU MALE OR FEMALE?"

N %

***** *****

Male 1574 87.8

Female 219 12.2

***** *****

TOTAL 1793 100.0

Question number three. "HOW DO YOU DESCRIBE YOURSELF?".

N %

***** *****

Hispanic 336 18.9

White - not Hispanic 483 27.1

Black - not Hispanic 820 46.1

Asian or Pacific Islander 32 1.8

Native American or Alaskan 31 1.7

Other 78 4.4

***** *****

TOTAL 1780 100.0

Question number four. "HOW LONG HAVE YOU BEEN IN THIS FACILITY?" THIS MEANS "THIS TIME" ONLY.

N %

***** *****

Less than one week 153 8.5

1 week to less than 1 month 271 15.1

1 month to less than 4 months 483 27.0

months to less than 6 months 275 15.3

6 months or longer 610 34.0

***** *****

TOTAL 1792 100.0

Question number five. "SINCE COMING TO THIS FACILITY, HAVE YOU GONE TO THE NURSE OR DOCTOR FOR HEALTH PROBLEMS?" This does not include the first time you saw the nurse or doctor when you first entered the facility. It means after you entered.

N %

***** *****

Yes 1201 67.1

No 589 32.9

***** *****

TOTAL 1790 100.0

Question number six. "DURING THE 12 MONTHS PRIOR TO COMING TO THIS FACILITY, HOW MANY TIMES WERE YOU IN A PHYSICAL FIGHT?"

N %

***** *****

None 555 30.9

1 time 228 12.7

2 or 3 times 336 18.7

4 or 5 times 164 9.1

6 or 7 times 90 5.0

8 or 9 times 68 3.8

10 or 11 times 34 1.9

12 or more times 319 17.8

***** *****

TOTAL 1794 100.0

Question number seven: "DURING THE 12 MONTHS PRIOR TO COMING TO THIS FACILITY, HOW MANY TIMES HAVE YOU BEEN IN A FIGHT IN WHICH YOU WERE INJURED AND HAD TO BE TREATED BY A DOCTOR OR A NURSE?"

N %

***** *****

0 times 1344 74.9

1 time 263 14.7

2 or 3 times 124 6.9

4 or 5 times 25 1.4

6 or more times 39 2.2

***** *****

TOTAL 1795 100.0

QUESTION NUMBER EIGHT: "IN YOUR ENTIRE LIFE, HOW MANY TIMES HAVE YOU BEEN IN A FIGHT IN WHICH A WEAPON (SUCH AS A GUN, KNIFE, RAZOR, CLUB, OR BAT) HAS BEEN USED,, EITHER BY YOU OR SOMEONE ELSE?"

N %

***** *****

0 times 423 23.6

1 time 213 11.9

2 or 3 times 255 14.2

4 or 5 times 180 10.0

6 or 7 times 98 5.5

8 or 9 times 74 4.1

10 or 11 times 46 2.6

12 or more times 507 28.2

***** *****

TOTAL 1796 100.0

QUESTION NUMBER NINE: "HAVE YOU EVER JOINED A GANG?"

N %

***** *****

Yes 827 46.1

No 967 53.9

***** *****

TOTAL 1794 100.0

QUESTION NUMBER TEN: "HOW OLD WERE YOU WHEN YOU FIRST JOINED A GANG?"

N %

***** *****

I have never joined a gang 948 53.2

Less than 9 years old 46 2.6

9 or 10 years old 119 6.7

11 or 12 years old 236 13.2

13 or 14 years old 282 15.8

15 or 16 years old 137 7.7

17 or more years old 15 .8

***** *****

TOTAL 1783 100.0

QUESTION NUMBER ELEVEN: "HAVE YOU EVER TRIED CIGARETTE SMOKING, EVEN ONE OR TWO PUFFS?"

N %

***** *****

Yes 1570 87.6

No 223 12.4

***** *****

TOTAL 1793 100.0

QUESTION NUMBER TWELVE: "HOW OLD WERE YOU WHEN YOU SMOKED A WHOLE CIGARETTE FOR THE FIRST TIME?"

N %

***** *****

I have never smoked a full cigarette 342 19.2

Less than 9 years old 231 13.0

9 or 10 years old 274 15.4

11 or 12 years old 412 23.1

13 or 14 years old 330 18.5

15 or 16 years old 182 10.2

17 or more years old 11 .6

***** *****

TOTAL 1782 100.0

QUESTION NUMBER THIRTEEN: "DURING THE PAST 12 MONTHS, DID YOU EVER SERIOUSLY CONSIDER ATTEMPTING SUICIDE?"

N %

***** *****

Yes 391 21.8

No 1399 78.2

***** *****

TOTAL 1790 100.0

QUESTION NUMBER FOURTEEN: "DURING THE PAST 12 MONTHS, DID YOU MAKE A PLAN ABOUT HOW YOU WOULD ATTEMPT SUICIDE?"

N %

***** *****

Yes 349 19.5

No 1439 80.5

***** *****

TOTAL 1788 100.0

QUESTION NUMBER FIFTEEN: "DURING THE PAST 12 MONTHS, HOW MANY TIMES, IF ANY, DID YOU ACTUALLY ATTEMPT SUICIDE?"

N %

***** *****

0 times 1508 84.5

1 time 115 6.4

2 or 3 times 89 5.0

4 or 5 times 24 1.3

6 or more times 48 2.7

***** *****

TOTAL 1784 100.0

QUESTION NUMBER SIXTEEN: "IF YOU ATTEMPTED SUICIDE DURING THE PAST 12 MONTHS, DID ANY ATTEMPT RESULT IN AN INJURY, POISONING, OR OVERDOSE THAT HAD TO BE TREATED BY A DOCTOR OR NURSE?"

N %

***** *****

I did not attempt suicide 961 54.5

Yes 145 8.2

No 656 37.2

***** *****

TOTAL 1762 100.0

QUESTION NUMBER SEVENTEEN: "HOW OLD WERE YOU WHEN YOU HAD YOUR FIRST DRINK OF ALCOHOL OTHER THAN A FEW SIPS?"

N %

***** *****

I have never had a drink of alcohol 207 11.6

Less than 9 years old 357 20.0

9 or 10 years old 284 15.9

11 or 12 years old 370 20.8

13 or 14 years old 381 21.4

15 or 16 years old 171 9.6

17 or more years old 11 .6

***** *****

TOTAL 1781 100.0

QUESTION NUMBER EIGHTEEN: "DURING YOUR LIFE, ON HOW MANY DAYS HAVE YOU HAD AT LEAST ONE DRINK OF ALCOHOL?"

N %

***** *****

0 days 254 14.3

1 or 2 days 229 12.9

3 to 9 days 233 13.1

10 to 19 days 179 10.0

20 to 39 days 157 8.8

40 to 99 days 152 8.5

100 or more days 578 32.4

***** *****

TOTAL 1782 100.0

QUESTION NUMBER NINETEEN: "DURING THE 30 DAYS PRIOR TO COMING TO THIS FACILITY, ON HOW MANY DAYS DID YOU HAVE FIVE OR MORE DRINKS OF ALCOHOL IN A ROW, THAT IS, WITHIN A COUPLE OF HOURS?"

N %

***** *****

0 days 809 45.4

1 day 125 7.0

2 days 140 7.9

3 to 5 days 225 12.6

6 to 9 days 125 7.0

10 to 19 days 135 7.6

20 or more days 224 12.6

***** *****

TOTAL 1783 100.0

QUESTION NUMBER TWENTY: "IF YOU HAVE EVER TRIED MARIJUANA, (pot, grass, etc), HOW OLD WERE YOU WHEN YOU TRIED IT FOR THE FIRST TIME?"

N %

***** *****

I have never tried marijuana 351 19.7

Less than 9 years old 205 11.5

9 or 10 years old 236 13.2

11 or 12 years old 367 20.6

13 or 14 years old 424 23.8

15 or 16 years old 182 10.2

17 or more years old 17 1.0

***** *****

TOTAL 1782 100.0

QUESTION NUMBER TWENTY ONE: "DURING YOUR LIFE, HOW MANY TIMES, IF ANY, HAVE YOU USED MARIJUANA?" ("USED" MEANS TRYING IT MORE THAN ONCE).

N %

***** *****

0 times 368 20.6

1 or 2 times 167 9.4

3 to 9 times 170 9.5

10 to 19 times 161 9.0

20 to 39 times 181 10.1

40 or more times 739 41.4

***** *****

TOTAL 1786 100.0

QUESTION NUMBER TWENTY TWO: "IF YOU HAVE EVER TRIED ANY FORM OF COCAINE, INCLUDING POWDER, CRACK, OR FREEBASE, HOW OLD WERE YOU WHEN YOU TRIED IT FOR THE FIRST TIME?"

N %

***** *****

I have never tried cocaine in any form 1224 68.6

less than 9 years old 27 1.5

9 or 10 years old 28 1.6

11 or 12 years old 73 4.1

13 or 14 years old 228 12.8

15 or 16 years old 183 10.3

17 or more years old 22 1.2

***** *****

TOTAL 1785 100.0

QUESTION NUMBER TWENTY THREE: "DURING YOUR LIFE, HOW MANY TIMES HAVE YOU USED ANY FORM OF COCAINE INCLUDING POWDER, CRACK, OR FREEBASE?" ("USED" MEANS TRYING IT MORE THAN ONCE).

N %

***** *****

0 times 1243 69.5

1 or 2 times 178 10.0

3 to 9 times 135 7.6

10 to 19 times 61 3.4

20 to 39 times 45 2.5

40 or more times 126 7.0

***** *****

TOTAL 1788 100.0

QUESTION NUMBER TWENTY FOUR: "DURING YOUR LIFE, HOW MANY TIMES HAVE YOU USED THE CRACK OR FREEBASE FORMS OF COCAINE?" (USED MEANS TRYING IT MORE THAN ONCE).

N %

***** *****

0 times 1409 78.7

1 or 2 times 136 7.6

3 to 9 times 90 5.0

10 to 19 times 50 2.8

20 to 39 times 32 1.8

40 or more times 73 4.1

***** *****

TOTAL 1790 100.0

QUESTION NUMBER TWENTY FIVE: "DURING YOUR LIFE, HOW MANY TIMES HAVE YOU USED ANY OTHER TYPE OF ILLEGAL DRUG, SUCH AS LSD, PCP, ECSTASY, MUSHROOMS, SPEED, ICE, HEROIN OR PILLS WITHOUT A DOCTOR'S PRESCRIPTION?" ("USED" MEANS TRYING IT MORE THAN ONCE).

N %

***** *****

0 times 1175 65.7

1 or 2 times 148 8.3

3 to 9 times 119 6.7

10 to 19 times 102 5.7

20 to 39 times 63 3.5

40 or more times 181 10.1

***** *****

TOTAL 1788 100.0

QUESTION NUMBER TWENTY SIX: "DURING YOUR LIFE HAVE YOU EVER INJECTED (SHOT UP) ANY ILLEGAL DRUG?" (INCLUDING SKIN POPPING OR INJECTING STEROIDS).

N %

***** *****

Yes 202 11.3

No 1583 88.7

***** *****

TOTAL 1785 100.0

QUESTION NUMBER TWENTY SEVEN: "DO YOU HAVE A TATTOO?" (THIS MEANS A PERMANENT TATTOO).

N %

***** *****

Yes 663 37.1

No 1123 62.9

***** *****

TOTAL 1786 100.0

QUESTION NUMBER TWENTY EIGHT: "HOW OLD WERE YOU WHEN YOU GOT THE TATTOO?" (THIS MEANS A PERMANENT TATTOO).

N %

***** *****

I have never gotten a tattoo 1115 62.5

less than 9 years old 40 2.2

9 or 10 years old 39 2.2

11 or 12 years old 105 5.9

13 or 14 years old 234 13.1

15 or 16 years old 220 12.3

17 or more years old 30 1.7

***** *****

TOTAL 1783 100.0

QUESTION TWENTY NINE: "HAVE YOU EVER BEEN TAUGHT ABOUT AIDS OR HIV INFECTION IN SCHOOL BY AN ADULT, EITHER IN THIS FACILITY OR ELSEWHERE?"

N %

***** *****

Yes 1547 86.4

No 184 10.3

Not sure 60 3.4

***** *****

TOTAL 1791 100.0

QUESTION THIRTY: "DO YOU KNOW WHERE TO GET GOOD INFORMATION ABOUT AIDS OR HIV INFECTION? ("GOOD INFORMATION" MEANS ACCURATE AND USEFUL INFORMATION).

N %

***** *****

Yes 1381 77.1

No 275 15.4

Not sure 135 7.5

***** *****

TOTAL 1791 100.0

QUESTION THIRTY ONE: "HAVE YOU EVER TALKED ABOUT AIDS OR HIV INFECTION WITH A PARENT OR OTHER ADULT OUTSIDE OF SCHOOL?"

N %

***** *****

Yes 1123 62.8

No 586 32.8

Not sure 80 4.4

***** *****

TOTAL 1789 100.0

QUESTION THIRTY TWO: "CAN A PERSON GET AIDS OR HIV INFECTION FROM BEING BITTEN BY MOSQUITOES OR OTHER INSECTS?"

N %

***** *****

Yes 268 15.0

No 1141 63.7

Not sure 381 21.3

***** *****

TOTAL 1790 100.0

QUESTION THIRTY THREE: "CAN A PERSON GET AIDS OR HIV INFECTION FROM DRINKING FROM THE SAME GLASS AS SOMEONE WHO ALREADY HAS AIDS OR HIV INFECTION?"

N %

***** *****

Yes 147 8.2

No 1401 78.3

Not sure 241 13.5

***** *****

TOTAL 1789 100.0

QUESTION THIRTY FOUR: "HAVE YOU EVER WILLINGLY HAD SEX? WILLINGLY MEANS YOU WERE NOT FORCED." ("SEX" MEANS HAVING ANY KIND OF SEX WITH ANOTHER PERSON).

N %

***** *****

Yes 1663 93.1

No 123 6.9

***** *****

TOTAL 1786 100.0

QUESTION THIRTY FIVE: "HOW OLD WERE YOU THE FIRST TIME YOU WILLINGLY HAD SEX?" (WILLINGLY MEANS YOU WERE NOT FORCED).

N %

***** *****

I have never willingly had sex 87 4.9

Less than 12 years old 668 37.5

12 years old 443 24.9

13 years old 292 16.4

14 years old 183 10.3

15 years old 70 3.9

16 years old 28 1.6

17 or more years old 8 .4

***** *****

TOTAL 1779 100.0

QUESTION THIRTY SIX: "IN YOUR ENTIRE LIFE, WITH HOW MANY DIFFERENT PERSONS HAVE YOU WILLINGLY HAD SEX?"

N %

***** *****

I have never willingly had sex 85 4.8

1 person 94 5.3

2 persons 94 5.3

3 persons 100 5.6

4 persons 125 7.0

5 persons 101 5.7

6 to 10 persons 299 16.8

11 to 20 persons 272 15.3

more than 20 persons 610 34.3

***** *****

TOTAL 1780 100.0

QUESTION THIRTY SEVEN: "THE LAST TIME YOU WILLINGLY HAD SEX, DID YOU OR YOUR PARTNER USE A CONDOM?" (A CONDOM IS A RUBBER).

N %

***** *****

I have never willingly had sex 86 4.8

Yes 551 31.0

No 1139 64.2

***** *****

TOTAL 1776 100.0

QUESTION THIRTY EIGHT: "THE LAST TIME YOU WILLINGLY HAD SEX BEFORE COMING TO THIS FACILITY, DID YOU OR YOUR PARTNER DRINK ALCOHOL OR USE DRUGS BEFORE HAVING SEX?"

N %

***** *****

I have never willingly had sex 127 7.2

Yes, alcohol only 349 19.7

Yes, drugs only 87 4.9

Yes, alcohol and drugs 261 14.8

Neither alcohol or drugs 945 53.4

***** *****

TOTAL 1769 100.0

QUESTION THIRTY NINE: "THE LAST TIME YOU WILLINGLY HAD SEX BEFORE COMING TO THIS FACILITY, WHAT METHOD DID YOU OR YOUR PARTNER USE TO PREVENT PREGNANCY."

N %

***** *****

I have never willingly had sex 96 5.6

No method was used 759 44.3

Birth control pills 176 10.3

Condoms (rubbers) 398 23.2

Withdrawal 137 8.0

Another method not listed above 55 3.2

Not sure 91 5.3

***** *****

TOTAL 1712 100.0

QUESTION FORTY: "THE LAST TIME YOU WILLINGLY HAD SEX BEFORE COMING TO THIS FACILITY, DID YOU OR YOUR PARTNER USE ANY FORM OF PROTECTION OTHER THAN A CONDOM TO PREVENT THE TRANSMISSION OF SEXUALLY TRANSMITTED DISEASES SUCH AS SYPHILIS, GONORRHEA AND HIV?"

N %

***** *****

I have never willingly had sex 86 5.0

Yes 324 18.7

No 1324 76.3

***** *****

TOTAL 1734 100.0

QUESTION FORTY ONE: "HAVE YOU EVER BEEN FORCED TO HAVE SEX (THAT IS, THROUGH ABUSE OR ASSAULT)?"

N %

***** *****

Yes 269 15.5

No 1466 84.5

***** *****

TOTAL 1735 100.0

QUESTION FORTY TWO: "HOW MANY TIMES HAVE YOU BEEN PREGNANT OR GOTTEN SOMEONE PREGNANT?"

N %

***** *****

0 times 835 48.0

1 time 465 26.8

2 or more times 254 14.6

Not sure 184 10.6

***** *****

TOTAL 1741 100.0

QUESTION FORTY THREE: "HAVE YOU EVER BEEN TOLD BY A DOCTOR OR NURSE THAT YOU HAD A SEXUALLY TRANSMITTED DISEASE SUCH AS GENITAL HERPES, GENITAL WARTS, CHLAMYDIA, SYPHILIS, GONORRHEA, AIDS OR HIV INFECTION?" (THIS INCLUDES "CLAP", AND "DRIP" AND RELATED SLANG).

N %

***** *****

Yes 287 16.5

No 1454 83.5

***** *****

TOTAL 1741 100.0

QUESTION FORTY FOUR: "WOULD YOU BE INTERESTED IN LEARNING MORE ABOUT HEALTH CARE FOR YOURSELF?"

N %

***** *****

Yes 1397 80.7

No 335 19.3

***** *****

TOTAL 1732 100.0

QUESTION FORTY FIVE AND THE LAST QUESTION: "WOULD YOU BE INTERESTED IN BEING INVOLVED IN THE DEVELOPMENT OF HEALTH EDUCATION PROGRAMS FOR OTHER PEOPLE YOUR AGE?"

N %

***** *****

Yes 1174 68.0

No 553 32.0

***** *****

TOTAL 1727 100.0

Additionally two other variables were created and analyzed: state and type of institution (short term versus long term). Some N = 451 responded from short term facilities, and N = 1350 from long term facilities. The distribution by state was: New York, N = 288; Massachusetts, N = 150; Tennessee, N = 162; Wisconsin, N = 448; and Texas, N = 753.

DEMOGRAPHIC VARIATIONS AMONG CONFINED JUVENILES

Are there differences by sex and race on factors relating to the correctional experience for these confined juveniles ? The answer appears to be clearly affirmative. A significant difference emerged when comparing males and females on "time served" (Chi = 9.15 , p = .002). Females tended to report having been confined for the shorter period of time. As an illustration, 39.7 percent of the females reported being incarcerated for a period of four months or more compared to 50.6 percent of the males.

There is a significant finding when simply comparing sex by race of these confined juveniles. Focusing on the three largest racial groups only and examining the crosstabulation with sex as seen below. The most substantial difference here is that while confined white males constitute only 27.3 percent of the population, among the female confined juveniles white females constitute 45.6 percent of the population.

FREQUENCY DISTRIBUTION OF SEX BY RACE

Hispanic White Black

******** ****** *****

Female 28 100 91

Male 337 430 805

Chi = 32.7, p < .001

Another demographic tendency to emerge from this data has been previously reported in the literature and it has to do with the differences by sex in terms of the age of these confined. A significant difference emerged in comparing sex by age of these confined juveniles (Chi square = 26.7 , p < .001). Confined females are more likely to be younger than are males, particularly thirteen years of age or younger (10.9% females versus 4.3 percent males).

Significant differences also emerged in comparing sex by race as seen below.

FREQUENCY OF SEX BY RACE

Hispanic White Black Asian Native A&A Other

******** ***** ***** ***** *********** *****

Female 25 90 80 2 3 17

Male 309 392 739 30 28 60

Chi square = 38.4, p < .001

As seen above for the crosstabulation of sex by race, whites represent the largest single racial group in the female confined population (41.4%) and Blacks represent the largest single racial group in the male confined population (47.4%).

Gang membership may be considered a factor that constitutes a potential causal force with respect to why these juveniles are confined in the first place. Among these confined juveniles no significant difference emerged between the males and females in terms of prior gang membership. However, race was a factor significantly differentiating gang membership (Chi square = 43.8, p < .001). Hispanics clearly led in terms of their proportion ever being gang members (58.7%), compared to 46.5% of the Blacks and 36.7% of the whites.

FACTORS DIFFERENTIATING REPORTS OF STD's

The only current method for stopping the spread of AIDS/HIV infection appears to be through efforts at changing behavior associated with its transmission (Tyckoson, 1989). AIDS education has generally been successful in creating an awareness of the virus, but has had mixed results in changing specific behavior (Tyckoson, 1989).

To address the problem of HIV among adolescents the Division of Adolescent and School Health, a division of the Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control, provided both funding and technical assistance for a comprehensive school health education program to provide youths with accurate and timely information to protect them against HIV infection. In April of 1991 the U.S. Department of Health and Human Services released a 295 page report entitled HIV AND AIDS: A Cumulation of the AIDS School Health Education Database. This document contains citations and abstracts of more than 600 resources placed in the database through April of 1991. The database is a subfile of the Combined Health Information Database (CHID) which contains databases of Public Health Service agencies (Center for Disease Control, 1990).

An additional source of up-to-date information on AIDS is the Oryx Press Aids Bibliography Series, published from 1986 through 1990 in six volumes. The purpose of the series is to collect and evaluate the most significant material published each year concerning AIDS. Each publication contains references to over 500 of the most significant articles of a scientific, social or ethical aspect of the AIDS problem (Tyckoson, 1990).

The survey item in the present NCCHC Health Risk Survey dealing with self-reported cases of being diagnosed by health professionals as having a sexually transmitted disease (STD) included: genital herpes, genital warts, chlamydia, syphilis, gonorrhea, AIDS or HIV infection. Clearly, from the analysis of this data some factors significantly differentiate such reports of STD's.

Gender significantly differentiated reports of STD's (Chi square = 32.7, p < .001). Females were more likely (66 out of 211) than males (220 out of 1522) to report having been ever diagnosed as having an STD.

Youths who reported that since being placed in the correctional facility or institution they had seen a nurse or doctor for health problems also was a factor that significantly differentiated reports of STD's (Chi square = 13.92, p < .001). Those youths who had sought medical help in the facility for health problems were more likely (219 out of 1161) than youths who did not seek medical help for health problems (68 out of 570) to report having an STD.

Youths who reported that they had ever joined a gang was also a factor that significantly differentiated reports of STD's (Chi square = 8.1, p = .004). Those youths with a history of prior gang membership were more likely to report having an STD (154 out of 797) compared with non-gang affiliated youths (133 out of 937).

Race when comparing Hispanic, white and Black youths is a factor that significantly differentiated reports of STD's (Chi = 40.5, p < .001). Consistent with the work of Blumberg (1990: 159) Black youths were significantly more likely to report an STD (191 out of 865) than were Hispanic youths (42 out of 357) or white youths (54 out of 463).

Time served in these juvenile correctional facilities appears also to be a factor that significantly differentiates reports of STD's (Chi square = 8.1, p = .004). Youths who had served more than four months in the facility were more likely to report an STD (165 out of 867) than were youths who had served less than four months (122 out of 874). The crosstabulation of time served and reports of STD's are provided below.

FREQUENCY OF TIME SERVED BY STD REPORTS

Reported an STD?

Yes No

***** *****

Time Served: < one week 14 128

1 week - < 1 month 31 225

1 month - < 4 months 77 395

4 months - < 6 months56 210

6 months or longer 108 488

Chi square = 13.9, p = .010

Comparing the youths in terms of the extent of their prior physical fights did not significantly differentiate reports of STDs. Nor did being in fights in which weapons were used have any significant impact on reports of STDs; nor injuries sustained during fights.

The earlier these youths reported willingly having sex for the first time in terms of age, the more likely they were to report an STD (Chi square = 4.2, p = .03). Those youths were sexually active before or equal to 12 years of age were significantly more likely to report an STD (194 out of 1078) than were youths who reported they first had sex at age 13 or higher (79 out of 563).

The number of different persons during their lifetime with whom these youths have had sex was a factor that also significantly differentiated reports of STD's (chi square = 25.7, p < .001). Youths who reported 11 or more sexual partners were more likely to report an STD (185 out of 863) when compared to youths with ten or less sexual partners (95 out of 784). Among those who have willing had sex, the use of a condom the last time they had sex was not a factor that significantly impacted on reports of STD's .

However, among those who have willingly had sex it appears that the last time they had sex before their period of current incarceration, substance abuse was a factor that significantly differentiates reports of STDs. This crosstabulation is provided below.

FREQUENCY OF USING ALCOHOL OR DRUGS DURING THE

LAST TIME THE YOUTHS HAD SEX AND

REPORTS OF STD's

Reported an STD?

YES NO

******* *******

Did you or your partner drink

alcohol or use drugs before

having sex?

Neither alcohol or drugs 132 788

Yes, alcohol only 66 269

Yes, drugs only 22 63

Yes, alcohol and drugs 54 201

Chi square = 13.6, p = .003

Those youths in confinement who have ever been forced to have sex (i.e., through abuse or assault) were significantly more likely to report having an STD (Chi square = 39.3, p < .001). Thus youths experiencing forced sex were more likely to report an STD (82 out of 269) than were youths who reported no such forced sex (204 out of 1463).

Fertility appears to be a factor that significantly differentiates STD's among these youths (Chi = 52.1, p < .001). When asked "how many times have you been pregnant or gotten someone pregnant?" the crosstabulation below shows that STD reports are highest among those reporting getting someone or being pregnant two or more times.

FREQUENCY OF BEING PREGNANT OR GETTING SOMEONE

PREGNANT WITH REPORTS OF STD's

Report an STD?

YES NO

How many times have you been ***** *****

pregnant or gotten someone

pregnant? 0 times 95 737

1 time 77 388

>=2 times 80 174

Not sure 34 150

Chi square = 52.1, p < .001

Knowing whether these youths would be interested in learning more about health care for themselves was not a factor that significantly differentiated reports of STD's. However, their interest in being involved in the development of health education programs for other youths was a factor that significantly differentiates reports of STD's. As seen below, youths reporting an STD were significantly more likely to express an interest in being involved in the development of health education programs.

FREQUENCY OF INTEREST IN BEING INVOLVED IN

THE DEVELOPMENT OF HEALTH EDUCATION

PROGRAMS BY REPORTS OF STD's

Report an STD?

YES NO

Interested in being involved ***** *****

in the development of health

education programs for other

people your age? YES 217 956

NO 70 482

Chi square = 9.5, p = .002

Age of these youths is a factor that significantly differentiates reports of STD's. As seen below, the relationship appears to be the older the confined youth the higher the report of an STD.

FREQUENCY OF AGE CATEGORY OF CONFINED YOUTHS

BY REPORTS OF STD's

Report an STD?

YES NO

Age category of confined youths: ******* ******

<= 13 years 10 81

14 years 22 152

15 years 50 321

16 years 99 457

17 years 84 367

>= 18 years 21 71

Chi square = 14.2, p = .03

There was little variability in whether these youths reported cigarette smoking and it was not significant in differentiating reports of STD's; nor did age at first use of tobacco have any effect on reports of STD's.

The factors of suicide ideation and of attempted suicide significantly differentiate reports of STD's among these confined youths as seen below. Those youths reporting an STD were more likely to report suicide ideation.

FREQUENCY OF SUICIDE IDEATION BY

REPORTS OF STD's

Report an STD?

YES NO

During the past 12 months ****** ******

did you ever seriously

consider attempting suicide?

YES 81 300

NO 205 1147

Chi square = 7.6, p = .005

Similarly, those youths who reported that during the past 12 months they had made a plan about how they would attempt suicide were more likely to report an STD (21.7%) compared to confined youths who did not make such a plan (15.1%). This factor of making a plan for suicide significantly differentiates reports of STD's (Chi square = 7.9, p = .004). Additionally, as seen below, the number of actual attempts at suicide significantly differentiates reports of STD's; with the above relationship holding: those with STD's have a much higher rate of attempted suicide.

FREQUENCY OF SUICIDE ATTEMPTS BY

REPORTS OF STD's

Report an STD?

YES NO

During the past 12 months ****** ******

how many times did you

actually attempt suicide? 0 219 1243 (14.9%)

1 to 3 times 45 151 (22.9%)

4 or more times 22 49 (30.9%)

Chi square = 18.8, p < .001

The related factor of health threats from injury, poisoning, or an overdose that had to be treated by a doctor or nurse from an attempted suicide during the past 12 months also significantly differentiated reports of STDs (chi square = 10.4, p = .003). Those needing medical attention from a suicide attempt had the highest reported percentage of an STD (26.2%), compared with those who made no attempt at suicide (14.8%) and those who attempted suicide by did not require medical attention (16.9%).

Knowing whether these youths had ever, during their life, injected (shot up) any illegal drug was also a factor that significantly differentiated reports of STDs (Chi square = 15.5, p < .001). Some 26.7 percent of these confined youths with IV drug abuse experience reported having an STD compared to 15 percent of those youths without any history of IV drug abuse.

Having a tattoo was not significant in differentiating reports of STD. Nor was the knowing where to get good information about AIDS or HIV infection related to reports of STD's. Similarly, whether the youths had ever talk about AIDS or HIV infection with a parent or other adult outside of school had no effect on reports of STD's. Misinformation about AIDS, that is, whether a person can get AIDS or HIV infection from drinking from the same glass as someone who already has AIDS or HIV infection as well as from a mosquito bite had no effect on STD reports.

A discriminant analysis was undertaken to examine how well some of these variables were able to correctly predict confined youths who did or who did not report ever having been diagnosed with an STD. The predictor variables included sex, time served, seeing the nurse or doctor for health problems since being incarcerated, gang membership, age at time first willingly had sex, number of different sexual partners during the lifetime, and whether forced to have sex through abuse or assault. Discriminant analysis is a multivariate statistic often used for prediction and in Screening For Risk (SFR) (e.g., classification) applications. It is somewhat beyond the limited scope for this technical report on the results of the NCCHC Health Risk Survey, however even this modest level of analytical effort was able to generate a discriminant function that correctly classified 66.4 percent of the cases. This is shown below, where the type II error of 7.9 percent of the sample (N = 1,603) in predicting these confined juveniles to not have an STD who actually had an STD (N = 128).

PREDICTED CLASSIFICATION

************************

Ever Diagnosed with STD?

YES NO

********* **********

ACTUAL DATA:

Ever Diagnosed with STD?

YES 142 128

NO 410 923

From this result it would appear that further secondary analysis of the data would be warranted for purposes of devising such screening for risk (SFR) applications. The value of such analytical tools are for the effective administration of health care in these juvenile correctional institutions. Such data, for example, if collected at intake could be effectively used to screen for the risk of suicide as well. Again, though, such work is very time consuming and well beyond the limited purposes of providing a technical report on the major findings from the NCCHC Health Risk Survey.

FACTORS AFFECTING DRUG AND SUBSTANCE ABUSE

The health risks assumed by the abuse of alcohol are, it appears, well known to both the general public and the adolescent population. In a 1990 survey of adults by Crowley, 87 percent of the 2400 respondents indicated they believed the consumption of alcohol posed a risk to health. Among teenagers, Norman and Harris report that 62 percent of drinkers and 69 percent of non-drinkers believed that drinking alcohol was bad for ones health (Norman and Harris, 1981).

On the other hand, a 1984 study by the Metropolitan Life Insurance Company of 17,700 high school seniors nationwide indicated that 93 percent of the 12th graders had used alcohol and 70 percent had consumed alcohol within the last 30 days (Metropolitan, 1984). In the last decade the average number of "problem drinkers" in the U.S. teenage population has averaged an estimated one million per year (Hales, 1989). It therefore appears that youths, like adults, are generally aware of the health risks of alcohol consumption and are still attracted to consume alcoholic beverages.

The Institute for Social Research of the University of Michigan, under the auspices of the National Institute on Drug Abuse annually publishes a report entitled The Use of Licit and Illicit Drugs by America's High School Students. In its 12th national survey, covering 1987, over 91 percent of seniors reported having tried alcohol, 85 percent report having used it within the last year, 65 percent with the 30 days prior to the survey, and 4.8 percent report using it daily (U.S. Department of Human Service, 1987). It appears that adolescents, while generally aware of the health risks of alcohol consumption, are still attracted to the consumption of alcoholic beverages.

The Institute for Social Research study cited above also indicated that 61 percent of the high school students reporting using illicit drugs in their lifetime. Indeed 40 percent reported the use of drugs other than marijuana and alcohol. Cocaine had been used by 16 percent of the students and 12 percent reported using it within the year prior to the survey. Approximately 70 percent of students have smoked cigarettes in their lifetime, with almost 20 percent, or one out of five, reporting tobacco use within the 30 days prior to the survey.

The period during adolescence is a time of exploration and discovery. Teenagers are both aware of the dangers of drug use and the most frequent users of drugs (Bandura, 1990). In the Norman and Harris survey 55 percent of the adolescents agreed that smoking marijuana was harmful to health, but 26 percent did not agree it was injurious to health, and another 19 percent did not know one way or the other (Norman and Harris, 1981). It is estimated that approximately 2 out of 3 adolescents in America have smoked marijuana by the time they reach the age of 16 (Weissman, 1988). According to a report from the Secretary of the Department of Health and Human Services in 1987 there are an estimated 5 million adolescents who are problem drinkers in the United States and the problem is growing (Bowen, 1987).

Several items on the survey measured aspects of drug and substance abuse among these confined juveniles. The analysis of this data found some of these health risk behaviors to be inter-correlated. A correlation analysis shown below illustrates how some of these variables are associated with each other.

PEARSON CORRELATION MATRIX

VAR18 VAR19 VAR20 VAR21 VAR22 VAR23 VAR24 VAR25 VAR26

Age .13 .10 .16 .20 .16 .14 .08 .07 -.03

VAR4 .04 .06 .004 .09 .05 .07 .04 .06 -.04

VAR6 .23 .24 -.02 .18 .06 .16 .15 .21 -.10

VAR7 .12 .16 -.02 .11 .12 .19 .20 .21 -.20

VAR8 .22 .20 .06 .30 .08 .15 .09 .15 -.07

VAR15 .10 .08 .03 .06 .15 .25 .24 .26 -.24

VAR35-.08 -.04 .25 -.10 .02 .01 .01

VAR36 .13 .08 -.10 .17 .01 .03 -.008

Incarcerated white juveniles reported a significantly higher tendency to abuse alcohol. As seen below 64 percent of the whites reported 20 more days in which they had at least one drink of alcohol compared to 45.3 percent of the Hispanics and 43.1 percent of the Blacks confined in these same juvenile facilities.

FREQUENCY OF RACE BY REPORTS OF HEAVY DRINKING

Alcohol Drinking History

Low High

<= 19 days >= 20 days

in Lifetime in Lifetime

*********** ***********

RACE Hispanic 199 165

White 190 338

Black 505 383

Chi square = 61.3, p < .001

Some factors had no effect on low or high alcohol drinking history (number of days they had at least one drink of alcohol) including time served in the juvenile correctional facility and whether they have seen the nurse or doctor for any health problems since being incarcerated.

Some factor of aggression appears to have a relationship with this factor of lifetime days during which these juveniles have had at least one drink of alcohol. As seen below, physical fights is a variable that significantly differentiates alcohol abuse.

FREQUENCY OF FIGHTING BEHAVIOR BY ALCOHOL

ABUSE HISTORY AMONG JUVENILES

Alcohol Drinking History

Low High

<= 19 days >= 20 days

in Lifetime in Lifetime

*********** ************

Fighting Behavior:

# of physical fights during

the 12 months prior to being

incarcerated. <= 1 477 298

>= 2 414 586

Chi square = 70.9, p < .001

Similarly, fighting with deadly weapons (e.g., gun, knife, razor, club or bat), prior gang membership, and suicide ideation significantly differentiates lifetime alcohol drinking history as shown below. Again, the same pattern emerges, with the more aggressive juvenile having the higher alcohol abuse pattern.

FREQUENCY OF FIGHTING WITH DEADLY WEAPONS,

GANG MEMBERSHIP, SUICIDE IDEATION,

AND SUICIDE PLANNING AMONG CONFINED JUVENILES

BY LIFETIME ALCOHOL ABUSE HISTORY

Alcohol Drinking History

Low High

<= 19 days >= 20 Days

in Lifetime in Lifetime

*********** ***********

Frequency of using deadly

weapons during entire lifespan

in fights (e.g., gun, knife,

razor, club or bat). <=3 times 521 363

>=4 times 371 522

Chi square = 53.7, p < .001

Gang membership: Yes 368 451

No 521 435

Chi square = 16.1, P < .001

Suicide ideation:

Yes 138 252

No 754 634

Chi square = 43.6, P < .001

Made suicide plan past 12 months:

Yes 124 224

No 768 660

Chi square = 36.8, p < .001

A related question on drinking tended to measure health risk behavior on alcohol intoxication. It asked the confined juvenile to indicate how many days during the month prior to being incarcerated that five or more drinks of alcohol were consumed in a short period (e.g., in a row, within a couple of hours). The data shows this type of health risk behavior to also be associated with factors such as physical fights, fights with deadly weapons, gang membership, suicide ideation, and suicide planning among these confined juveniles as seen below.

FREQUENCY OF PHYSICAL FIGHTS, FIGHTS WITH DEADLY WEAPONS, GANG MEMBERSHIP, SUICIDE IDEATION, AND SUICIDE PLANNING BY REPORTS OF HEAVY DRINKING

Any Heavy Drinking 30 Days

Before Being Incarcerated? (zero Days) (>= 1 Day)

********** **********

Physical Fights in Last 12

Months prior to incarceration:

0 to 1 432 344

>= 2 372 638

Chi square = 60.1, p < .001

Fights with deadly weapons

during lifetime: 0 to 3 475 407

>= 4 333 563

Chi square = 49.9, p < .001

Have you ever joined a gang? Yes 313 501

No 490 472

Chi square = 27.7, p < .001

During the past year did you ever

seriously consider attempting suicide?

Yes 138 252

No 668 720

Chi square = 19.9, p < .001

During the past year did you make

a plan how to attempt suicide? Yes 125 223

No 680 748

Chi square = 15.4, p < .001

The incidence of heavy alcohol drinking among these confined juveniles is not independent of heavy marijuana use, they are in fact significantly related. As shown below, the incidence of heavy drinking during the 30 day period prior to incarceration significantly differentiates low and high levels of marijuana use.

FREQUENCY OF HEAVY DRINKING BY HEAVY MARIJUANA USE AMONG

CONFINED JUVENILES

Level of Lifetime Marijuana Usage

Low High

<= 19 Times >= 20 times

*********** ***********

During month before being

incarcerated had 5 or more

drinks of alcohol in a row?

0 Days 535 271

>= 1 Day(s) 327 642

Chi square = 187.5, p < .001

Days ever had at least one

drink of alcohol: <= 19 Days 616 274

>= 20 Days 244 639

Chi square = 306.8, p < .001

Heavy marijuana use, like the alcohol abuse variables, appears to be related to factors such as physical fights, fights involving deadly weapons, gang membership, suicide ideation, and suicide planning.

FREQUENCY OF PHYSICAL FIGHTS, FIGHTS WITH

DEADLY WEAPONS, GANG MEMBERSHIP, SUICIDE IDEATION, AND SUICIDE PLANNING BY HEAVY MARIJUANA USE AMONG

CONFINED JUVENILES

Level of Lifetime Marijuana Usage

Low High

<= 19 Times >= 20 times

*********** ***********

Physical fights during the

year before being

incarcerated: <= 1 451 330

>= 2 412 586

Chi square = 47.5, p < .001

Fights during lifetime that

involved deadly weapons:

<= 3 559 327

>= 4 305 591

Chi square = 150.5, p < .001

Have you ever joined a gang?

YES 331 488

NO 531 430

Chi square = 38.9, p < .001

During the past 12 months

ever seriously consider

attempting suicide? YES 153 236

NO 710 682

Chi square = 16.5, p < .001

During the past 12 months

made a plan about to

attempt suicide: YES 140 207

NO 722 710

Chi square = 11.3, p = .001

Reports by these confined juveniles of ever using any form of cocaine (including powder, crack, or freebase) is a variable that is not independent of other substance abuse health risk behaviors. Ever using cocaine is clearly related to factors such as alcohol and marijuana usage as shown below.

FREQUENCY OF ALCOHOL AND MARIJUANA ABUSE BY COCAINE ABUSE AMONG CONFINED JUVENILES

Ever Use Any Form of Cocaine?

NO YES

********** **********

Days in the month prior to

incarceration drank 5 or

more drinks of alcohol in a row:

0 Days 665 140

>=1 Day(s) 553 417

Chi square = 133.8, p < .001

Times ever used marijuana:

<= 19 times 739 123

>= 20 times 482 436

Chi square = 227.8, p < .001

Those health risk behaviors shown above to significantly differentiate alcohol and marijuana abuse also have the same effect on cocaine abuse. Factors significantly differentiating cocaine users among the confined juvenile population include physical fighting, fighting with deadly weapons, gang membership, suicide ideation, and suicide planning. These results are provided below.

FREQUENCY OF PHYSICAL FIGHTS, FIGHTS WITH

DEADLY WEAPONS, GANG MEMBERSHIP, SUICIDE IDEATION AND PLANNING BY EVER USING ANY FORM OF COCAINE AMONG CONFINED JUVENILES

Ever Use Any Form of Cocaine?

NO YES

******** ********

# of physical fights during

the year before being incarcerated:

<= 1 583 198

>= 2 636 361

Chi square = 23.9, p < .001

# of fights with deadly weapons

during lifetime: <= 3 661 224

>= 4 562 334

Chi square = 29.6, p < .001

Ever joined a gang? YES 509 308

NO 711 251

Chi square = 27.6, p < .001

During the past year ever seriously

consider attempting suicide? YES 193 197

NO 1029 362

Chi square = 80.8, p < .001

During the past year ever make a

plan how to attempt suicide? YES 171 177

NO 1048 383

Chi square = 71.3, p < .001

The specific use of crack or freebase forms of cocaine by these confined juveniles is not independent of other forms of substance abuse. As shown below, if these confined juveniles abuse other substances (e.g., alcohol, marijuana) they are more likely to also report abusing crack or freebase forms of cocaine.

FREQUENCY OF ALCOHOL AND MARIJUANA ABUSE BY EVER USING THE CRACK OR FREEBASE FORMS OF COCAINE AMONG CONFINED JUVENILES

Ever use Crack or Freebase

Forms of Cocaine?

**************************

NO YES

********** **********

Days During the Month Prior

to being incarcerated that

5 or more drinks of alcohol

consumed in short period:

0 Days 708 100

>=1 Day(s) 693 279

Chi square = 70.1, p < .001

# times used marijuana

during lifetime: <= 19 times 774 90

>= 20 times 629 290

Chi square = 118.6, p < .001

Crack and freebase forms of cocaine abuse are also associated with health risk behaviors such as fighting, gang membership, suicide ideation and planning. Crosstabulation results are provided below.

FREQUENCY OF PHYSICAL FIGHTS, FIGHTS WITH

DEADLY WEAPONS, GANG MEMBERSHIP, SUICIDE

IDEATION AND PLANNING BY USING THE CRACK OR FORMS OF COCAINE AMONG

CONFINED JUVENILES

Ever Use Crack or Freebase

Forms of Cocaine?

**************************

0 Times >=1 Time(s)

********* ***********

# physical fights during the

12 month period prior to

being incarcerated: <= 1 651 130

>= 2 753 249

Chi square = 17.6, p < .001

# fights during lifetime

involving a deadly weapon:

<= 3 729 157

>=4 678 221

Chi square = 12.5, p < .001

Ever joined a gang? Yes 611 209

No 794 169

Chi square = 16.7, p < .001

Ever seriously consider attempting

suicide during the past 12 months?

Yes 239 152

No 1167 227

Chi square = 84.3, p < .001

Ever make a plan about how to attempt

suicide during the past 12 months?

Yes 209 140

No 1194 240

Chi square = 91.4, p < .001

The use other illegal and illicit drugs by these confined juveniles was also measured on the NCCHC Health Risk Survey. This item elicited the number of times during their life these youths had used any other type of illegal drug, such as LSD, PCP, ecstasy, mushrooms, speed, ice, heroin or pills without a doctor's prescription. Again, this drug abuse variable is not independent of other forms of substance abuse as seen below.

FREQUENCY OF ALCOHOL, MARIJUANA, COCAINE, AND CRACK BY ABUSE OF OTHER

ILLEGAL DRUGS AMONG

CONFINED JUVENILES

Abused Other Illegal Drugs?

***************************

0 Times >= 1 Time(s)

********** ************

# days during the month

before incarceration had

5 or more drinks of alcohol

in a row: 0 Days 654 155

>= 1 Day(s) 516 454

Chi square = 149.7, p < .001

# times ever used marijuana:

<= 19 times 715 147

>= 20 times 455 464

Chi square = 220.6, p < .001

Ever tried any form of cocaine:

No 1022 199

Yes 149 412

Chi square = 557.0, p < .001

# times ever used crack or

freebase forms of cocaine:

0 times 1104 303

>=1 times 70 310

Chi square = 478.6, p < .001

The abuse of other illegal drugs such as LSD, PCP, ecstasy, mushrooms, speed, ice, heroin or pills without a doctor's prescription is significantly differentiated by health risk behaviors such as physical fights, fighting with deadly weapons, gang membership, suicide ideation, and suicide planning. The results of these crosstabulations are provided below.

FREQUENCY OF PHYSICAL FIGHTS, FIGHTS WITH DEADLY WEAPONS, GANG MEMBERSHIP, SUICIDE IDEATION, AND SUICIDE PLANNING BY REPORTS OF USING OTHER ILLEGAL DRUGS AMONG CONFINED JUVENILES

Used LSD, PCP, ecstasy, mushrooms, speed, ice, heroin or pills without a doctor's prescription?

***********************************

0 times >= 1 time(s)

********** ************

# physical fights in the year

before being incarcerated:

<= 1 time 593 187

>=2 times 578 423

Chi square = 65.07, p < .001

# fights in lifetime using

deadly weapons: <= 3 times 620 264

>= 4 times 553 346

Chi square = 14.7, p < .001

Ever joined a gang? Yes 516 301

No 654 310

Chi square = 4.30, p = .038

During past 12 months ever

consider attempting suicide?

Yes 149 241

No 1023 370

Chi square = 160.8, p < .001

During past 12 months ever

plan how to attempt suicide?

Yes 136 212

No 1033 400

Chi square = 129.0, p < .001

Finally the survey also asked the confined juveniles whether during their life they had ever injected (i.e., shot up) any illegal drug. Here again this form of substance abuse is not independent of other forms of drug abuse. Injecting illegal drugs is also significantly differentiated by health risk behaviors such as fighting, gang membership, suicide ideation and suicide planning. These results are provided below.

FACTORS SIGNIFICANTLY DIFFERENTIATING INJECTING ILLEGAL DRUGS AMONG

CONFINED JUVENILES

Ever Injected (shot up)

any illegal drug?

***********************

Yes No

********* *********

# days in the month before

incarceration had 5 or more

drinks of alcohol in a row:

0 days 51 756

>=1 days 149 819

Chi square = 36.2, p < .001

# times used marijuana:

<= 19 times 58 803

>= 20 times 144 773

Chi square = 36.6, p < .001

Ever tried any form of cocaine?

No 41 1179

Yes 161 398

Chi square = 229.01, p < .001

# times used crack or freebase

forms of cocaine: 0 times 68 1337

>=1 times 134 245

Chi square = 223.3, p < .001

# times used other types of

illegal drugs: 0 times 40 1132

>= 1 times 162 448

Chi square = 204.8, p < .001

# physical fights in the year

before being incarcerated:

<= 1 time 65 714

>= 2 times 134 865

Chi square = 11.3, p = .001

# fights during lifetime that

involved use of deadly weapons:

<= 3 times 84 800

>= 4 times 117 779

Chi square = 5.61, p = .018

Ever joined a gang? Yes 111 705

No 91 871

Chi square = 7.49, p = .006

During past 12 months ever

seriously consider suicide?

Yes 94 296

No 107 1283

Chi square = 70.1, p < .001

During past 12 months ever

make a plan about suicide?

Yes 86 261

No 115 1316

Chi square = 65.7, p < .001

FACTORS DIFFERENTIATING SUICIDE VARIABLES

The incidence of suicide among the adolescent population has been steadily increasing for several decades. According to the U.S. National Center for Health Studies, in 1955 about one in three suicides in the American population were adolescents. By 1985 this figure had reached one in two, or 50 percent of all suicides (National Center for Health Studies, 1986; Schleifer, 1988).

About 5,000 teenagers commit suicide each year. For each success there are an estimated 100 attempts which fail. Male adolescents are five times more likely to successfully commit suicide than females, but females attempt suicide more frequently than males (Hermes, 1987). Female adolescents successfully commit suicide in an estimated one out of fifty attempts compared to males who are successful in one out of fifteen to twenty attempts (Curran, 1978). Recent findings from a short term juvenile correctional facility showed that "female detainees were more likely to report suicidal thoughts and attempts than males (38.7% to 20.2%)" (Forst and Goddard, 1991: 44).

The official statistics only tell half of the story, according to many experts . The figures "grossly underestimate actual rates" according to one expert (Curran, 1987). It is generally believed that the actual rate is 50 percent higher than official figures would have us believe (Schrut, 1964; Peck, Farlerow, and Litman, 1985; Mishara, 1987).

Depression is a factor linked to suicide in adolescents. According to the American Psychiatric Association between 3 and 6 million adolescents in the United States suffer from depression (1989). Among the leading factors which contribute to depression are personal loss, low self-esteem, loneliness, stress, poor coping skills, and the abuse of drugs and alcohol (Hales, 1989). Of the factors indicated in the literature to be most strongly associated with depression is the strong link between depression and the abuse of drugs and alcohol (Malmquist, 1983; Greist and Jefferson, 1984; Wetzel, 1989). Depression, in turn, is a major cause of suicide. One researcher called drug and alcohol abuse "the most common and characteristic symptom of suicide attempts" (Crumley, 1981). This position was supported by the research of Weissman (1974) and Mishara (1985). The relationship between drug use (including alcohol) and suicide is both strong (McIntire and Schlicht, 1980) and historical in nature (Greuling and DeBlassie, 1980).

The currently accepted idea is that suicide can be prevented among confined juveniles with adequate staff training and procedures (Rowan, 1989). Research by Rakis (1984) showed that most line staff (82.7%) and supervisory staff (78.8%) did receive in-service training in suicide prevention within juvenile facilities. The research by Knox (1991) showed that using the statutory guidelines in Illinois for juvenile corrections , which requires three components for the mandatory suicide prevention program (enhance self-esteem, increase life coping skills, and decrease the propensity to commit self-destructive acts) were found in 71 percent of the state training schools.

Four variables on the NCCHC Health Risk Survey are measures of different aspects of adolescent suicide . While of much importance in the general population this problem takes on an even greater significance for the juvenile correctional population examined here. For example, some states like Illinois have statutory guidelines for the administration of juvenile correctional facilities that require a suicide prevention program for confined juveniles.

The approach to the analysis of this health risk issue is simply a systematic one. All possible relationships between the variables were examined. With four different variables dealing with the suicide problem in a forty-five item survey that meant 180 such possible statistical relationships. Findings of significance are presented below in a summary format.

The dependent variables examined here are different measures of the adolescent suicide problem. Suicide ideation (item 13) measures whether the confined juvenile ever seriously considered attempting suicide during the past 12 month period. Suicide planning (item 14) measures whether the confined juvenile ever made a plan about how to attempt suicide during the past 12 month period. Suicide attempting measures how many times the confined juvenile actually attempted suicide during the past 12 month period. Finally, suicide injuries measures whether the confined juvenile had to be treated by a doctor or nurse because of a suicide attempt during the past 12 month period.

The summary table on the next page provides the results of these 180 separate statistical tests of the relationship, if any, between all 45 of the survey questions and the four measures relating to adolescent suicide. Factors that are consistently providing a higher likelihood of suicide risk for all four measures of adolescent suicide include the drug and substance abuse history questions (items 17 through 26), tattoos (items 27 and 28), substance abuse during last sex (item 38), and self-reported sexual abuse (item 41). Demographic factors also figure prominently here, with lower age, white ethnicity, and females showing higher likelihood of suicide risk behaviors.

For the reader who wants to examine the frequencies for all of these four suicide variables crosstabulated with all other variables in the survey, please refer to Appendix J. The volume of these statistical results are more appropriate in an Appendix for technical reference purposes. As can be seen from the Appendix J, the crosstabulation of all variables by all of the four suicide variables entails over 180 pages of statistical results. It is, therefore, a more reasonable procedure to provide the summary statistical table which appears on the next page.

A discriminant analysis seeking to explain suicide ideation was made using the predictor variables of race, sex, physical fights, number of times injured in a fight, lifetime days with at least one drink of alcohol, ever tried any form of cocaine, ever get a tattoo, and number of persons with whom willingly had sex. The results below correctly classified 68 percent of this sample.

But some 8.7 percent of the sample (153 of 1747) were predicted not

have suicide ideation when they did in fact actually report it.

RESULTS OF DISCRIMINANT ANALYSIS

PREDICTED OUTCOME OF SUICIDE IDEATION

Actual Suicide

Ideation YES NO

YES 228 153

NO 404 962

SUMMARY TABLE FOR THE EFFECTS OF ALL

SURVEY ITEMS ON THE FOUR

SUICIDE MEASURES

The Four Measures of Adolescent Suicide

(item 13) (item 14) (item 15) (item 16)

IDEATION PLANNING # ATTEMPTS INJURIES

Item 1 (age) *** ns *** *

Item 2 (sex) *** *** *** ***

Item 3 (race) *** *** *** ***

Item 4 (time served) ns ns ns ns

Item 5 (seen nurse) *** * ns ns

Item 6 (fist fights) *** *** *** ***

Item 7 (fight injuries) *** *** *** ***

Item 8 (weapon fights) ns ns * ns

Item 9 (Gang member) ns ** *** ***

Item 10 (age joined) ns * *** **

Item 11 (ever smoked) *** *** ns *

Item 12 (age smoked) *** *** *** ***

Item 13 (Ideation) SAME *** *** ***

Item 14 (planning) *** SAME *** ***

Item 15 (# attempts) *** *** SAME ***

Item 16 (injuries) *** *** *** SAME

Item 17 (age drink) *** *** *** ***

Item 18 (days drink) *** *** *** ***

Item 19 (days intox) *** *** *** ***

Item 20 (age pot) ** ns * **

Item 21 (# pot use) *** *** ns *

Item 22 (cocaine age) *** *** *** ***

Item 23 (cocaine use) *** *** *** ***

Item 24 (crack form) *** *** *** ***

Item 25 (# other drugs) *** *** *** ***

Item 26 (IV drug use) *** *** *** ***

Item 27 (have tattoo) *** * *** ***

Item 28 (Age tattooed) *** * *** ***

Item 29 (taught AIDS) ns ns *** ***

Item 30 (AIDS info) ns ns * *

Item 31 (AIDS talk) ns ns ns ns

Item 32 (AIDS insect) ns ns ns *

Item 33 (AIDS glass) ns ns ns ***

Item 34 (willing sex) ns ns ns ns

Item 35 (age w/sex) ns ns * ns

Item 36 (# sex persons) *** ** *** ns

Item 37 (use condom) ns ns ns **

Item 38 (sex&substance) *** *** *** ***

Item 39 (birth control) ns ns ns ***

Item 40 (STD protect.) ns ns ns **

Item 41 (sex abuse) *** *** *** ***

Item 42 (pregnancy) ns * *** ***

Item 43 (ever STD's) ** ** *** **

Item 44 (learning) ** ns ** *

Item 45 (programs) ns ns ns *

LEGEND: ns = not significant by Chi-square distribution

*** = .001 ** = .01 * = .05 levels of significance

Examining the second measure of adolescent suicide behavior that of whether the confined youth actually made a plan about how to attempt suicide within the past twelve months, another discriminant analysis was made. The predictor variables here included: sex, fights in which the youth was injured, lifetime days had at least one drink of alcohol, ever used cocaine in any form, ever used crack or freebase forms of cocaine, ever used any other illegal drugs, and ever injected any illegal drug. The results of this discriminant analysis corrected classified 69.4 percent of the cases in predicting suicide planning, with 7 percent of the sample being predicted not to plan suicide when in fact they did report such a suicide plan as seen below.

DISCRIMINANT ANALYSIS PREDICTING SUICIDE PlANNING

PREDICTED SUICIDE PLANNING OUTCOME

YES NO

ACTUAL REPORTS

OF SUICIDE PLANNING

YES 216 123

NO 410 997

Efforts to predict the actual number of times that suicide was attempted by these confined youths (item 15) provided a discriminant analysis that was no better than chance alone in correctly classifying the sample. Little improvement was made in predicting injuries sustained during such attempts (item 16).

The only caveat here is that such multivariate statistical modelling involves an extensive level of manpower effort and while beyond the scope of the present analysis it would appear worthwhile for such secondary analysis on at least the first two measures of adolescent suicide health risk behaviors (suicide ideation and suicide planning) given the encouraging results from a cursory level of higher level statistical analysis as described above.

There are trade-offs, however, with such prediction methodologies. This can be briefly illustrated here using a new variable called "SUICIDE RISK" created from all four of the suicide measures. The variable "suicide risk" was a grouped variable, coded "yes" if the respondent answered yes to items 13 or 14, or if item 15 involved more than one attempt, or if item 16 showed "yes" for treated injuries. This combined suicide risk variable showed that 25.8 percent of the sample would be included as a suicide risk by showing some health risk behaviors reported in the survey that were commonly self-destructive. Presented below is a discriminant analysis of this "suicide risk" variable using predictor variables of items 6, 7, 8, 18, 19, 26, 43, and 25.

DISCRIMINANT ANALYSIS OF THE

SUICIDE RISK VARIABLE

Predicted Outcome

Not Yes

Suicidal Suicidal

******** ********

ACTUAL OBSERVATION:

Not suicidal 967 291

Yes suicidal 201 238

This discriminant analysis therefore was better at correctly classifying the sample correctly at a rate of 71 percent. However, the false negative rate was also higher; with 11.8 percent being predicted not to be suicidal who were in fact suicidal from their own reports.

FACTORS DIFFERENTIATING GANG MEMBERSHIP

Outside of the Camp and Camp (1985) study where the unit of analysis was adult state prison systems (not individual correctional institutions) and which had much missing data on states reluctant to report on this problem, the only other research on gangs in corrections is that by Robert Fong and his associates (Fong, 1987, 1990; Fong and Buentello, 1991; Fong, Vogel and Little, 1991; Fong, Vogel and Buentello, 1991) focusing exclusively on gangs in adult Texas prisons and that by Knox (1991) focusing on juvenile and adult correctional institutions nationwide. There has never been any research reported in the literature involving a survey of actual juveniles detained in correctional facilities nationwide regarding the gang problem. The present effort, therefore, has much knowledge to offer regarding this most important social policy issue.

The most significant finding, not from a statistical viewpoint but from a knowledge development viewpoint, from the present analysis is that such a large proportion of these confined juveniles report ever having joined a gang. Recall that 46.1 percent of the juveniles from the present national survey reported such gang membership. The Camp and Camp (1985) research estimated that only three percent of our nation's adult prison population was gang affiliated. The recent research by Knox (1991) using a more rigorous unit of analysis showed that this figure was over ten percent for adult institutions, and even higher for juvenile correctional institutions .

The methodological improvement of the present study is that its unit of analysis is the individual confined juvenile and represents data from short and long term facilities in five different states. The findings below suggest that gang membership is associated with other health risk behaviors as well.

While age and sex are independent of gang membership, race of these confined juveniles significantly differentiates gang membership. While our sample included few Native Americans or Alaskan Natives (N=31), 11 of them reported gang membership. Similarly, there were few Asian or Pacific Islander respondents (N = 32), but 21 of them reported gang membership. Overall, the largest proportion of gang membership was found among Hispanics (59.4%), followed by Blacks (46.3%) and whites (34.8%).

Time served showed that gang members had been incarcerated longer than their non-gang member counterparts (p = .03). Some 70.5 percent of the gang members had gone to the nurse or doctor for health problems since being incarcerated compared to 64.2 percent of non-gang member juveniles (p = .004). As might be expected from the hypothesis that gang members would be more aggressive or prone to conflict, the number of physical fights during the twelve month period before incarceration also significantly differentiated gang membership. Some 63.1 percent of the gang members reported two or more such physical fights compared to 50.5 percent of their non-gang counterparts (p < .001). Similarly, gang members were significantly more likely to report one or more injuries sustained from these fights (p < .001). The potential deadly nature of some of these conflicts shows gang members face a significantly higher likelihood of being injured as well when comparing the number of fights in which deadly weapons were used (p < .001). As an illustration, some 67.9 percent of the gang members had 4 or more such fights involving deadly weapons during their lifetime compared to 35.3 percent of youths who were not gang members.

Gang members are significantly more likely to report cigarette smoking when compared to non-gang members (p < .001). While 23.1 percent of the gang members reported suicide ideation compared to 20.7 percent of their non-gang counterparts this was not a significant difference. Where the significant difference emerges is in making a plan for suicide within the last twelve months. Gang members showed a significantly higher tendency to make a suicide plan (22.2%) than did non-gang members (17.2%) (p = .008). Also, gang members reported making more such actual suicide attempts than did their non-gang counterparts (p = .001).

Also, gang members were more likely to have to be treated by a doctor or nurse for such attempts (p = .001). For example, 10.3 percent of the gang members reported required such medical treatment for suicide attempt injuries compared to 6.3 percent of their non-gang counterparts.

With the longstanding linkage between drugs and street gangs it comes as no surprise to find strong consistent relationships between drug and substance abuse variables and gang membership among these confined juveniles. Gang membership significantly differentiates all measures of drug and substance abuse as seen below.

DRUG AND SUBSTANCE ABUSE VARIABLES

SIGNIFICANTLY DIFFERENTIATING

GANG MEMBERSHIP AMONG

CONFINED JUVENILES

Variable Relationship/Direction Probability

Item 17 (age 1st drink) Gang drink earlier < .001

Item 18 (days drinking) Gang members drink more < .001

Item 19 (heavy drinking) Gang members drink more < .001

Item 20 (age pot use) Gang members use pot earlier .02

Item 21 (# pot uses) Gang members use more pot < .001

Item 22 (cocaine use) Cocaine use higher for gangs < .001

Item 23 (# cocaine uses)Gangs use more cocaine < .001

Item 24 (crack use) Crack use higher for gangs < .001

Item 25 (other drugs) Gangs use more other drugs .03

Item 26 (IV drug use) Gang members shoot up more .006

In a recent survey providing a partial replication of the famous Chicago Safe School study (Tromanhauser, 1981) data collected in June, 1991 among over 500 Chicago high school students showed 32.5 percent of the gang members had permanent tattoos compared to only 9 percent of non-gang affiliated Chicago public high school students. In some of the more organized gangs in America, children at a very early age whose parents are gang members have their offspring tattooed with their gang sign, and for gang members the permanent tattoo is another form of gang expression and representation (Knox, 1991).

Among these confined juveniles having permanent tattoos significantly differentiated gang membership (p < .001). Some 45.7 percent of the gang members had permanent tattoos compared to 29.6 percent of non-gang juveniles. Gang members also reported getting these tattoos at an earlier age than their non-gang counterparts (p < .001).

While there was little variation among these confined juveniles in reporting whether or not they have ever willingly had sex, gang members showed a higher rate of reporting that they had willingly had sex (p = .02). Gang members were significantly more likely to report willingly having sex at age twelve or earlier than non-gang juveniles (p < .001) and to report having sex with more persons (p = .008). Consistent with the earlier tendency for gang members to have a higher drug and substance abuse history, they were also more likely to report using drugs and alcohol during the last time they had sex before their incarceration (p < .001).

During the last time these confined youths had sex before being incarcerated, gang membership also differentiated those who did not use any method to prevent pregnancy (p = .02). Gang members were more likely not to use birth control options. Of course, gang members were significantly more likely to report being pregnant or getting someone pregnant (p < .001). Finally, consistent with the findings just discussed, gang membership significantly differentiates reports of being diagnosed with an STD among these confined juveniles. Gang members are more likely to report an STD (19.3% for gang members, 14.1% for non-gang members) (p = .004).

FACTORS DIFFERENTIATING AIDS/HIV INFORMATION

Several of the survey items measured aspects of AIDS/HIV information for these confined juveniles. These included items 29 through 33 as well as items 44 and 45 in terms of learning and participation interests among these confined juveniles regarding health care programs.

Item 29 measured whether these youths had ever been taught about AIDS or HIV infection in school by an adult. There was no difference on this variable when comparing short and long term correctional facilities. Nor did age or sex significantly differentiated responses to this item. Race was significant in differentiating this item (p = .02). This difference by race showed that whites had the highest prior rate of being taught about AIDS or HIV infection (91%), compared to 82.6 percent for Hispanics.

Item 30 measured whether these youths knew where to get good information about AIDS or HIV infection. Here the type of facility (short or long term) did make a difference (p = .006). Youths confined in short term facilities had the lowest response (71%) in reporting they knew where to get good information about AIDS or HIV infection when compared with youths in long term correctional facilities (81.7%). Age also significantly differentiated this information variable (p < .001), with the general trend being that the younger the confined juvenile the more they were likely to report that they did not know or they were not sure where to get good information about AIDS or HIV infection. Sex produced no significant differences on this item. However, race again significantly differentiated this information variable as well (p = .03) with the same tendency for Hispanics to lack information access.

Item 31 measured whether the youths had ever talked about AIDS or HIV infection with a parent or other adult outside of school. Age significantly differentiated this factor (p = .004), with younger persons reporting less adult interaction in discussing AIDS or HIV infection. Sex also differentiated this factor (p = .02) with the relationship being that males showed the lowest proportion of adult interaction (61.6%) compared to females (70.5%). Race was again significant (p < .001) with the distribution showing Hispanics at the lowest range of adult interaction (54.9%), compared to 60.1 percent for whites, and 66.7 percent for Blacks. There was no difference on this variable in comparing short and long term facilities.

Item 32 asked the youths whether a person can get AIDS or HIV from being bitten by mosquitoes or other insects. Age showed no relationship to this variable. Sex, however, did significantly differentiate responses to this item about acquiring AIDS/HIV infection from mosquito or insect bites (p = .003). Males were more likely to say no (65%) compared to females (59.7%), and males were less likely to say yes or not sure (35%) compared to females (40.3%). Race also significantly differentiated this variable with Blacks being more likely to report yes (18.3%) compared to whites (11%) and Hispanics (13.7%). Type of institution (long term versus short term) had no effect on this variable.

Item 33 asked the youths whether a person can get AIDS or HIV from drinking from the same glass as someone who already has AIDS or HIV infection. Age significantly differentiated this variable (p < .001) with the relationship being the younger the confined juvenile the more they were likely to report yes. Sex had no effect on this variable. But again, race significantly differentiated this misinformation variable, with whites being the least likely to report in the affirmative (5.1%) compared to Blacks (9.9%). Knowing whether these youths were from a short or long term correctional facility made no difference.

Item 44 asked the youths whether they would interested in learning more about health for themselves. There were no differences by age, sex, or type of institution (short versus long term). Race was significant in relationship to this variable (p < .001). Whites were least likely to report such an interest (69.3%) compared to 83.2 percent for Hispanics and 86.8 percent for Blacks.

Item 45 asked the youths whether they would be interested in being involved in the development of health education programs for other people of their age. Age and type of institution had no effect on this variable. Sex significantly differentiated this variable (p < .001) with females being more likely to express such an interest (78.8%) compared to males (66.3%). Race also significantly differentiated this variable with the result being that whites were least likely to express such an interest (57.5%) compared to 68.9 percent for Hispanics and 75.4 percent for Blacks.

DIFFERENCES BETWEEN SHORT TERM AND LONG TERM FACILITIES

While less is known about the characteristics of juveniles confined in short term facilities, our literature does contain some information on youths confined in long term correctional institutions (Beck, Kline, and Greenfield, 1988). An effort was made to analyze the subsample of juveniles confined in long term facilities for purposes of comparison with the previous research by Beck, Kline and Greenfield (1988). Strictly, speaking these are different research methodologies, but there is enough in common between them to justify this analysis.

Basically, the Beck, et al (1988) research reported only 6.9 percent of the youths confined in long term state-operated correctional institutions were females. In the NCCHC Health Risk Survey no differentiation was made between state-operated and privately-operated facilities. The Beck (1988) study included a sample size of N = 2,621 and was based on personal interviews. The bias of the Beck study was in including persons over the age of 18. Indeed, nearly a fourth of their sample consisted of persons who were not juveniles but were youthful offenders or young adults and who were 18 years of age or older. Thus, the Beck study shows a much lower percentage of females in long-term facilities than does the present study (12.1%). As another comparison, however, the analysis of juveniles committed to state care in 1988 showed 13.8 percent were female (Camp and Camp, 1989); which comes much closer to the figure in the present research.

Therefore because of the over-representation of persons 18 years of age and older in the Beck, et al (1988) report, some caution is warranted in comparing other factors with the Beck, et al (1988) research. Another problem in such a comparison is how the Beck, et al (1988) study analyzed race. The Beck, et al (1988) analysis of race included only white (53.1%), Black (41.1%), and other (5.7%). It is not clear if Hispanics, which was treated as a separate variable for ethnicity, were classified as whites in the racial distribution within the Beck, et al (1988) analysis. However, Beck, et al (1988) reported that 18.9 percent of their sample was Hispanic.

In the present study the subsample for long term facilities indicates that racial minorities represent approximately three-fourths of the sample of the present study of confined juveniles. Whites in the present subsample of long term facilities make up only 25.9 percent of the sample.

The Beck, et al (1988) study did report findings on the history of illegal drug use among the sample, however it is difficult to compare because of methodological differences with the present study. Beck, et al (1988: p. 7) reported that among youths less than 18 years of age, 59.7 percent reported using any drug on a regular basis (used once a week or more for at least a month), 27.5 percent used a major drug (heroin, cocaine, LSD and PCP) on a regular basis, 57.5 percent used any drug in the month before the current offense, and 28.5 percent used a major drug in the month before the current offense; and for alcohol use, 76.2 percent drank some alcohol, 55.4 percent drank regularly (one or more times per week in the year before admission), and 65.4 percent got drunk at least once. While these findings of high drug use are consistent with our own findings, the nature of the measurements are very different.

In our longterm subsample, 89.6 percent reported drinking alcohol other than a few sips at some point in their life; 86.6 percent reported one or more days during their life during which they had at least one drink of alcohol; and perhaps the closest variable to the Beck, et al measure of drunkeness, in our sample 57.9 percent reported one or more days during the month before their incarceration that they had five or more drinks in a row, that is within a couple of hours.

A number of variables showed that there was no significance difference between short and long term facilities. These items for which the Chi-square statistic did not yield a probability level of less than or equal to .01 included the following variables: gang membership (item 9), age at joining a gang (item 10), cigarette smoking (items 11 and 12), suicide ideation (item 13), suicide planning (item 14), number of actual suicide attempts (item 15), injuries from suicide attempts (item 16), days during the month preceding incarceration had five or more drinks in a row (item 19), age first tried marijuana (item 20), age ever tried any form of cocaine (item 22), life time usage of crack or freebase forms of cocaine (item 24), whether ever injected (shot up) any illegal drug (item 26), having a tattoo (item 27), age when tattooed (item 28), ever taught about AIDS/HIV infection in school by an adult (item 29), ever talked about AIDS/HIV infection with a parent or other adult outside of school (item 31), whether they had ever willingly had sex (item 34), using a condom the last time willingly having sex (item 37), using alcohol or drugs before having sex prior to coming to the facility (item 38), whether used any method other than a condom to prevent the transmission of STD's during last time had sex before incarceration (item 40), whether the juvenile had ever been forced to have sex (i.e., through abuse or assault) (item 41), reports of getting someone or being pregnant (item 42), ever being diagnosed with an STD (item 43), whether the juvenile would be interested in learning more about health care (item 44), and whether the juvenile would be interested in being involved in the development of health education programs for other persons of their age (item 45). None of these distributions controlling for type of correctional institution (short term versus long term) were significant (p <= .01) by the Chi square test.

Before summarizing the significant differences between short and long term facilities it is appropriate to caution the reader that when conducting such blanket tests using all variables without regard to theory or specific hypothesis testing, in strict probability terms one test out of twenty is probably going to be significant anyhow . Which would mean that at least 2.25 times by chance alone we would get a significant Chi square test by making an analysis of all 45 items on the survey.

Generally, the short term facilities held juveniles who were younger than those in the long term facilities (p < .001). There was a higher percentage of females in long term facilities (p < .001). There was also a difference by race. What constituted the major source of variation for this difference appears to be among Black representation between short and long term facilities. There was a higher Black percentage in long term facilities.

As might have been expected by policy alone, there was a very significant difference between short and long term facilities in terms of the "time served" by the confined juveniles responding to this survey (Chi square = 336.1, p < .001).

Whether the confined juveniles had gone to the nurse or doctor for health problems since being confined in the facility produced a significant difference between short and long term correctional facilities (Chi square = 90.0, p < .001). A higher percentage of these youths reported seeing a doctor or nurse if they were in a long term facility.

Not unexpectedly, the youths confined in short term facilities reported significantly less physical fights during the twelve month period prior to their incarceration than did the youths in long term correctional facilities (p < .001). Additionally, the following significant differences emerged as well:

Short Term Facilities Long Term Facilities

Slightly higher smoking Earlier age first smoked

Higher drinking (item 18) Earlier age first drinking

Higher marijuana use

Higher % never used illicit drugs Higher cocaine use

Less AIDS information (item 30) Younger age first sexuality

More misinformed on AIDS (item 32) Higher # of sexual partners

More misinformed on AIDS (item 33) Less effective birth control

DIFFERENCES BY STATE

The sample is heavily weighted towards longterm facilities as shown below in the crosstabulation of facility type by state .

FREQUENCY DISTRIBUTION OF TYPE OF INSTITUTION

BY STATE

Type of

Institution: New York Mass. Tenn. Wisc. Texas

Short Term 77 38 130 36 170

Long Term 211 112 32 412 583

Chi square = 307.0, p < .001

Again, the probability level of .01 was used here for ascertaining statistically significant differences between states using the Chi-square test. Generally, a number of these variables showed no such significant difference by state. These included the following items: item 7, item 9, item 13, item 14, item 15, item 20, item 21, item 23, item 24, item 25, item 31, item 34, item 35, item 38, item 40, item 41, item 42, item 44, and item 45.

Those factors that emerged as significant along a state by state comparison are summarized in the figure on the next page. Please consult the appendix for a complete listing of all possible relationships between this factor of STATEID and the other variables in the survey.

Summary of Significant (p <= .01) Differences Between States

Survey Chi-Square Prob.

Item # Value Level General Trend in the data

Item 1 126.5 < .001 Older age youths in Wisconsin

Item 2 112.0 < .001 Higher % females in Tenn. & Mass.

Item 3 98.2 < .001 Higher % Blacks in Wisc. and

higher % Hispanics in Texas

Item 4 141.0 < .001 Shorter time served in Mass.

Item 5 33.2 < .001 Lower % seen doctor/nurse in Tenn.

Item 6 65.8 < .001 Higher fight frequency in New York

Item 8 53.4 .003 Higher armed fights in New York

Item 10 41.9 .006 Join gangs earlier age in New York

Item 11 17.0 .002 Lower % smokers in Texas

Item 12 48.7 .002 Smoke at earlier age in Tennessee

Item 16 22.4 .003 Suicide injuries higher in Tenn.

Item 17 49.3 .002 Earlier age use alcohol in New York

Item 18 44.5 .007 Higher drinking days in Tennessee

Item 19 44.8 .006 Heavier drinking in Tennessee

Item 22 45.0 .006 Earlier age using cocaine in

New York and Texas

Item 26 16.2 .003 Higher % IV drug abuse in Tenn.

Item 27 33.9 <.001 Higher % tattooed in Wisconsin

Item 28 55.0 <.001 Lower % tattoo at early age in Mass.

Item 29 32.8 <.001 Higher % schooled on AIDS in Mass.

Item 30 41.2 <.001 Lower % info on AIDS in Texas

Item 32 36.4 <.001 Higher % "NO" to AIDS virus from

mosquitos in New York

Item 33 37.4 <.001 Lower % "NO" to AIDS virus from drinking glass in Texas

Item 36 72.1 <.001 Higher # sexual partners in Wisc.

Item 37 22.3 .004 Higher % used condom in Mass.

Item 39 51.3 .001 Higher % no method used to prevent pregnancy in Tennessee

Item 43 16.6 .002 Higher % diagnosed with STD in Mass. and Tennessee

SUMMARY AND CONCLUSIONS

This has been a survey analysis of N = 1,801 respondents from juvenile correctional institutions located in five different states. The survey instrument contained forty five items which measured different aspects of health risk behaviors among adolescents. Two other variables created involved identifiers (short term vs. long term facililty, and state) of the juvenile institution and were also used, but not in a fashion that would allow the identification of any single facility because of the promise to these institutions that their facility would not be specifically reported in any analysis.

Major findings from the descriptive statistics for the sample showed the need for increased resources devoted to reducing the health risk behaviors of confined juveniles. Some of these national health risk problems for confined juveniles can be summarized as follows:

*** More than two-thirds were in a physical fight during the year before their incarceration.

*** A fourth sustained fighting injuries that had to be treated by a doctor or nurse during the year before their incarceration.

*** Three-fourths have at some time in their life been in a fight that involved the use of deadly weapons (e.g., gun, knife, razor, club, or bat).

*** Some 46.1 percent reported gang membership.

*** Most (87.6%) reported smoking cigarettes.

*** Nearly a fourth represented some level of suicide risk.

*** A fifth (21.8%) reported suicide ideation during the last year.

*** Nearly the same proportion (19.5%) reported making a suicide plan during the last year.

*** Some 15.5 percent reported one or more suicide attempts during the last year.

*** And 8.5 percent reported having to received medical treatment for injuries sustained in such a suicide attempt during the last year.

*** Most (85.7%) had one or more days in their life during which they had at least one drink of alcohol.

*** In fact, over half (54.6%) reported having five or more drinks of alcohol in a row during the month period before being incarcerated.

*** About four-fifths (80.3%) have tried marijuana.

*** About half (51.6%) have tried marijana 20 or more times.

*** Over a fourth (31.4%) have tried some form of cocaine.

*** Over a fifth (22.3%) have tried the crack or freebase forms of cocaine.

*** A third (34.3%) have tried other illegal drugs (LSD, PCP, ecstasy, mushrooms, speed, ice, heroin, pills).

*** Nearly one out of ten have "shot up" drugs (11.3%).

*** Over a third (37.1%) have a permanent tattoo.

*** Nearly a fourth (26.3%) either believed or were not sure that a persond could get AIDS/HIV infection from mosquitoe or other insect bites.

*** A sizable proportion (21.7%) either believed or were not sure that a person could get AIDS/HIV infection from drinking out of the same glass as someone who already has AIDS or HIV infection.

*** Over half willingly had sex on or before they were twelve years old.

*** About a third (34.3%) reported having sex with more than 20 different persons.

*** Less than a third (32.6%) reported that a condom was used the last time they willingly had sex.

*** Most did not use any form of birth control method or device during the last time they willingly had sex.

*** A substantial proportion (15.5%) report being forced to have sex through abuse or assault.

*** Over a third report either they got pregnant or had gotten someone pregnant.

*** A sixth (16.5%) reported previously being diagnosed as having a sexually transmitted disease.

These are major health risk behaviors that are represented within the juvenile correctional population. From a health care administration, health care education and program services point of view these problems represent an urgent agenda for action in American juvenile correctional institutions. Policy makers, administrators, and law makers cannot ignore these findings without risk of substantial legal liability represented by the adolescents they have the legal responsibility to care for .

Beyond these descriptive findings, further analysis was provided of major health risk problems in juvenile corrections today. These included: (1) Sexually Transmitted Diseases, (2) Drug and Substance Abuse, (3) Suicide, (4) Gang Membership, (5) AIDS/HIV information, as well as (6) differences between short and long term facilities. Major findings from each of these six areas are briefly summarized below.

(1) Sexually Transmitted Diseases (STD's)

Those confined juveniles who were significantly more likely to report an STD included the following types of experiential and behavioral profiles:

*** Older.

*** Females.

*** Those who sought health treatment since being confined.

*** Gang members.

*** Black youths.

*** Youths who have served more than four months.

*** Youths sexually active at age 12 or earlier.

*** Youths who reported 11 or more sexual partners.

*** Youths who abused drugs or alcohol during the last time they had sex before confinement.

*** Youths who have been sexually abused.

*** Youths who have been or gotten someone pregnant.

*** Youths with suicide ideation in the last year.

*** Youths who attempted suicide in the last year.

*** Youths who planned suicide in the last year.

*** Youths who have shot up drugs.

These are factors associated with reports of STD's, not necessarily causes. These were factors that in the Chi square test were significant (p < .05) in differentiating reports of STD's among confined juveniles. Using discriminant analysis some of these factors were able to predict STD's with a low level of correctly classifying the cases (66.4%).

(2) Substance Abuse.

Consistent with the tendency towards polydrug abuse (using one or more substances in combination) in the general population, there were significant inter-relationships between drug and alcohol abuse among these confined juveniles. It is useful to summarize the major findings in terms of individual measures of drug and alchol abuse.

The profile that emerges here in terms of those confined juveniles who are signficantly more likely to report alcohol abuse is as follows:

*** Whites.

*** Fighting behavior with and without weapons.

*** Gang membership.

*** Suicide ideation and planning.

*** Marijuana abuse.

The profile that emerges here in terms of explaining those confined juveniles who are significantly more likely to report marijuana abuse is as follows:

*** Fighting with and without weapons.

*** Gang membership.

*** Suicide ideation and planning.

*** Prior use of cocaine.

*** Heavy drinking.

The profile that emerges in terms of explaining those confined juveniles who are significantly more likely to report ever using any form of cocaine includes:

*** Fights with and without weapons.

*** Gang membership.

*** Suicide ideation and planning.

For crack and freebase users of cocaine the profile includes:

*** Heavy drinking.

*** Heavy marijuana use.

*** Fighting with and without weapons.

*** Gang membership.

*** Suicide ideation and planning.

These factors of fighting, gang membership, suicide risk (ideation and planning) were also significant in differentiating the abuse of other illegal drugs.

(3) Suicide.

A variety of factors were shown to significantly differentiate the four measures relating to suicide risk behavior among these confined juveniles. It would appear that other forms of self-destructive behavior such as fighting, substance abuse, sex abuse, contracting STD's and gang membership play a significant role in this problem of adolescent suicide among the confined population. While no direct measure of depression was available which is a leading hypothesis for this problem, it would appear that some health risk behaviors and experiences also have a significant role to play in explaining adolescent suicide behavior. There exists important sources of variation for the suicide problem by age, sex and race as well. Yet a discriminant analysis was able to correctly classify slightly over two-thirds of the cases in this sample regarding suicide ideation. It appears, therefore, to be a somewhat more complex problem than would appear from the literature and the present analysis and clearly warrants further analysis. There is a particularly urgent need to develop such quantitative statistical models for use in screening for risk (SFR) applications during the diagnostic and intake phases of entry into juvenile correctional facilities.

(4) Gang membership.

The value of the present study has been to document that there are clearly hidden costs to gang membership. The present study was also one of the first comparative analyses of gang membership among confined juveniles using the self-report method. Females were not any less likely than males to report gang membership. However, race did significantly differentiate gang membership. The higher the drug and substance abuse history, the higher the likelihood of gang membership.

(5) AIDS/HIV Information.

This research must conclude there exists an urgent need for bilingual AIDS/HIV information dissemination within the correctional population. Hispanics and Blacks, those in the greatest need of this information, are not unreceptive to such health care information programs would also be the conclusion from the present analysis. A large amount of misinformation has been accepted among the confined juvenile population regarding the spread of the AIDS/HIV virus.

(6) Type of Correctional Institution.

The analysis of differences, if any, between short and long term juvenile correctional institutions showed some significant differences did exist. The data analysis for this portion of the research consisted of that subsample that could be identified or who chose to be identified for purposes of data analysis. Generally, a profile of major differences emerged that can be summarized here.

The short term facility was more likely to:

*** Have younger persons confined.

*** Have fewer Blacks.

*** Have youths not reporting seeing a doctor or nurse for health problems.

*** Have youths with a lesser history of fighting.

*** Have youths with a lower problem of substance abuse.

*** Have youths with fewer tattoos.

*** Have youths who don't know where to get good information on AIDS/HIV.

*** Have youths with fewer number of previous sexual partners.

*** Have youths with fewer experiences with pregnancy.

*** Have youths who did not report having STD's.

Overall, a number of important social policy issues have emerged from this research that should command serious attention. These issues and recommendations are as follows.

(1) Smoking. Some juvenile correctional facilities have strict policies prohibiting smoking by anyone including staff. Many, however, allow the confined juveniles to smoke with their parents permission. This permissive policy on cigarette smoking should stop. Groups like the National Juvenile Detention Association and the American Correctional Association should address this issue in collaboration with health care groups to develop a method to phase out once and for all this harmful policy.

(2) Gang membership. As one of the first ever comparative analyses of self-reported gang membership among the confined population, nearly a half of these youths reported gang membership. We can only assume an equal or higher level of gang membership for the adult correctional institutions. No national standards or guidelines exist on how to deal with gangs inside correctional institutions. Such standards need to be provided along with intensive staff training.

(3) Suicide risks appear to be very high among the confined juvenile population and the present analysis suggests that this group may be able to be identified using screening for risk classification methods, involving multivariate statistical methods such as discriminant analysis. Further research and model development is urgently needed on this issue as a means to improve correctional administration.

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APPENDIX A

Guide to the Administration of the

NCCHC Health Risk Survey

MANUAL FOR THE HEALTH RISK SURVEY

These instructions are designed for the juvenile correctional staff member who supervises and administers the Health Risk Survey questionnaire.

Using this guid, it will take an average of 19 minutes to have groups of students complete the survey. It is important to follow these procedures as much as humanely possible. Obviously, some persons are more experienced at administering group tests, etc, than others. We have found this type of procedure to be best for controlling all possible problems.

Before Start-up

For each survey that is provided to your facility, there is also an equivalent number of sharpened pencils provided. Always keep about five extra sharpened pencils available. Some students as you know will break their pencil. When they raise their hand and want another pencil, have a pencil ready for them so they will not interrupt the continuity of the group completion process.

Before starting, make sure you have read through the complete instructions provided below. Our advice is to time yourself from beginning to finish. It should normally take about 19 minutes. Your tone of voice is very important. It should be clear, precise language in a steady tone. It should be a scientific tone. As if you were talking on radio or television. Loud enough to be heard by all students completing the survey.

We recommend that you avoid looking at any of the individual questionnaires being completed by the student. After all, we are trying to guarantee them total anonymity and confidentiality; so no one should ever really know who really completed any one particular questionnaire.

Steps in the Administration Process

Step one: surveys and pencils should be on the desk or table in front of the youths.

Step two: Instructions are read to the youths.

Time: one minute.

Step three: Survey is completed as a group.

Time: average of 19 minutes.

Step four: Debriefing of the students.

Time: Two minutes

Step five: Students with no questions leave the room, first placing their survey in the boxes provided.

Time: negligible.

Step six: Students with questions remain, dealt with one at a time.

Time: usually short.

Step One: Start-Up

Start up means getting the surveys and pencils distributed to the students. They can either pick one up from a large pile where each student can pick one survey and one pencil as they enter the room. Or the surveys and pencils can be laid out on the desks/tables before the student enters the room (which saves much time).

The most important thing is that the surveys be placed flatly on the desk or table surface area being used by the students. You do not want the students looking or reading the survey before you explain it to them.

So if you are allowing the students to pick up one of their own surveys and a pencil as they enter the room, your instruction would be this. Read this instruction so that everyone hears it, repeat as necessary during the hand-out phase:

"TAKE A SEAT, AND DO NOT LOOK AT YOUR SURVEY."

"PLACE THE SURVEY FLAT ON YOUR DESK DO NOT OPEN IT."

"THE SURVEY SHOULD BE FLAT ON YOUR DESK/TABLE, WITH THE INSTRUCTIONS ON THE FRONT PAGE SHOWING."

"ONCE IT IS FLAT IN FRONT OF YOU, DO NOT OPEN IT UNTIL I INSTRUCT YOU TO DO SO."

Or, if you use the recommended strategy of distributing the surveys and pencils at the desk/table areas before the students enter the room, then you would read this instruction:

"TAKE ANY SEAT YOU WANT. DO NOT OPEN THE SURVEY THAT IS IN FRONT OF YOU. DO NOT PICK IT UP. DO NOT OPEN IT UNTIL I TELL YOU TO. WE WILL BEGIN AS SOON AS EVERYONE TAKES A SEAT."

Once the above start-up phase is finished, we have completed step one of administering the survey.

Step Two: Oral Instructions to be Read for administering the survey to groups of youths.

The overall instructions to be read to the youths completing the survey are as follows:

"PLEASE LISTEN TO ME CAREFULLY. PLEASE DO NOT TALK DURING THIS SURVEY. LISTEN CAREFULLY TO WHAT I HAVE TO SAY, BECAUSE IT IS VERY IMPORTANT."

"THIS IS AN ANONYMOUS SURVEY. THAT MEANS NO NAMES. IT IS A NATIONAL SURVEY. IT CANNOT HELP YOU. IT CANNOT HURT YOU. WE NEED YOUR COOPERATION IN COMPLETING THIS SURVEY, BECAUSE IT MAY MEAN MUCH POSITIVE GOOD FOR YOUR SOCIETY."

"IT IS IMPORTANT TO TELL THE TRUTH. BE HONEST IN COMPLETING THE SURVEY. THIS SURVEY HAS QUESTIONS ABOUT HEALTH AND HEALTH PROBLEMS. SO PLEASE COOPERATE, AND FOLLOW MY INSTRUCTIONS EXACTLY AND WE CAN COMPLETE THIS IN THE TIME PROVIDED."

"ON THE FRONT OF YOUR SURVEYS, PLEASE BEGIN READING THE INSTRUCTIONS. DO NOT READ THEM ALOUD. READ THEM TO YOURSELF. I WILL READ THEM ALOUD SO WE CAN ALL FOLLOW IT TOGETHER."

"THIS SURVEY IS ABOUT HEALTH BEHAVIOR. IT HAS BEEN DEVELOPED SO YOU CAN TELL US WHAT YOU DO THAT MAY AFFECT YOUR HEALTH. THE INFORMATION YOU GIVE WILL BE USED TO DEVELOP BETTER HEALTH EDUCATION PROGRAMS FOR YOUNG PEOPLE LIKE YOURSELF."

"DO NOT WRITE YOUR NAME ON THIS SURVEY. THE ANSWERS YOU GIVE WILL BE KEPT PRIVATE. NO ONE WILL KNOW WHAT YOU WRITE. ANSWER THE QUESTIONS BASED ON WHAT YOU REALLY DO."

"COMPLETING THE SURVEY IS VOLUNTARY. WHETHER OR NOT YOU ANSWER THE QUESTIONS WILL NOT AFFECT YOUR STANDING IN THIS FACILITY."

"THE QUESTIONS THAT ASK ABOUT YOUR BACKGROUND WILL ONLY BE USED TO DESCRIBE THE TYPES OF STUDENTS COMPLETING THIS SURVEY. THE INFORMATION WILL NOT BE USED TO FIND OUT YOUR NAME. NO NAMES WILL EVER BE REPORTED."

"PLACE ALL YOUR ANSWERS ON THE SURVEY FORM ITSELF. CIRCLE ONLY ONE ANSWER FOR EACH QUESTION. MAKE SURE TO ANSWER EVERY QUESTION. WHEN YOU ARE FINISHED, FOLLOW THE INSTRUCTIONS OF THE PERSON GIVING YOU THE SURVEY."

"THANK YOU VERY MUCH FOR YOUR HELP."

Step Three:

At this point the actual completion of the survey begins.

"YOU CAN PICK UP YOUR PENCILS NOW AND OPEN THE BOOKLET. WE WILL START WITH QUESTION NUMBER ONE."

(Begin reading the questions and instructions below.)

Question number one, "HOW OLD ARE YOU?" CIRCLE the answer for your current age.

Question number two, "ARE YOU MALE OR FEMALE?" CIRCLE your answer.

Question number three. "HOW DO YOU DESCRIBE YOURSELF?". CIRCLE one answer (White, Black, Hispanic, Asian, Native American, Alaskan, or other).

Question number four. "HOW LONG HAVE YOU BEEN IN THIS FACILITY?" THIS MEANS "THIS TIME" ONLY. CIRCLE one answer.

Question number five. "SINCE COMING TO THIS FACILITY, HAVE YOU GONE TO THE NURSE OR DOCTOR FOR HEALTH PROBLEMS?" Circle one answer. This does not include the first time you saw the nurse or doctor when you first entered the facility. It means after you entered.

Question number six. "DURING THE 12 MONTHS PRIOR TO COMING TO THIS FACILITY, HOW MANY TIMES WERE YOU IN A PHYSICAL FIGHT?" CIRCLE one answer.

Question number seven: "DURING THE 12 MONTHS PRIOR TO COMING TO THIS FACILITY, HOW MANY TIMES HAVE YOU BEEN IN A FIGHT IN WHICH YOU WERE INJURED AND HAD TO BE TREATED BY A DOCTOR OR A NURSE?" CIRCLE ONE ANSWER.

QUESTION NUMBER EIGHT: "IN YOUR ENTIRE LIFE, HOW MANY TIMES HAVE YOU BEEN IN A FIGHT IN WHICH A WEAPON (SUCH AS A GUN, KNIFE, RAZOR, CLUB, OR BAT) HAS BEEN USED,, EITHER BY YOU OR SOMEONE ELSE?" CIRCLE ONE ANSWER.

QUESTION NUMBER NINE: "HAVE YOU EVER JOINED A GANG?" CIRCLE ONE ANSWER.

NOW WE MUST GO TO THE NEXT PAGE. FIND THE PAGE WITH QUESTION NUMBER TEN IN THE UPPER LEFT HAND CORNER. EVERYONE READY?

QUESTION NUMBER TEN: "HOW OLD WERE YOU WHEN YOU FIRST JOINED A GANG?" CIRCLE ONE ANSWER.

QUESTION NUMBER ELEVEN: "HAVE YOU EVER TRIED CIGARETTE SMOKING, EVEN ONE OR TWO PUFFS?" CIRCLE ONE ANSWER.

QUESTION NUMBER TWELVE: "HOW OLD WERE YOU WHEN YOU SMOKED A WHOLE CIGARETTE FOR THE FIRST TIME?" CIRCLE ONE ANSWER.

CONCERNING THE NEXT FOUR QUESTIONS. SOMETIMES PEOPLE FEEL SO DEPRESSED AND HOPELESS ABOUT THE FUTURE THAT THEY MAY CONSIDER ATTEMPTING SUICIDE,, THAT IS, TAKING SOME ACTION TO END THEIR OWN LIFE.

QUESTION NUMBER THIRTEEN: "DURING THE PAST 12 MONTHS, DID YOU EVER SERIOUSLY CONSIDER ATTEMPTING SUICIDE?" CIRCLE ONE ANSWER.

QUESTION NUMBER FOURTEEN: "DURING THE PAST 12 MONTHS, DID YOU MAKE A PLAN ABOUT HOW YOU WOULD ATTEMPT SUICIDE?" CIRCLE ONE ANSWER.

QUESTION NUMBER FIFTEEN: "DURING THE PAST 12 MONTHS, HOW MANY TIMES, IF ANY, DID YOU ACTUALLY ATTEMPT SUICIDE?" CIRCLE ONE ANSWER.

QUESTION NUMBER SIXTEEN: "IF YOU ATTEMPTED SUICIDE DURING THE PAST 12 MONTHS, DID ANY ATTEMPT RESULT IN AN INJURY, POISONING, OR OVERDOSE THAT HAD TO BE TREATED BY A DOCTOR OR NURSE?" CIRCLE ONE ANSWER.

THE NEXT THREE QUESTIONS ASK ABOUT DRINKING ALCOHOL. THIS INCLUDES DRINKING BEER, WINE, WINE COOLERS, AND LIQUOR SUCH AS RUM, GIN, VODKA, OR WHISKEY. FOR THESE QUESTIONS, DRINKING ALCOHOL DOES NOT INCLUDE DRINKING A FEW SIPS OF WINE FOR RELIGIOUS PURPOSES.

QUESTION NUMBER SEVENTEEN: "HOW OLD WERE YOU WHEN YOU HAD YOUR FIRST DRINK OF ALCOHOL OTHER THAN A FEW SIPS?" Circle one answer.

QUESTION NUMBER EIGHTEEN: "DURING YOUR LIFE, ON HOW MANY DAYS HAVE YOU HAD AT LEAST ONE DRINK OF ALCOHOL?: Circle one answer.

NOW WE MUST GO TO THE NEXT PAGE. FIND THE PAGE WITH QUESTION NUMBER NINETEEN IN THE UPPER LEFT HAND CORNER. EVERYONE READY?

QUESTION NUMBER NINETEEN: "DURING THE 30 DAYS PRIOR TO COMING TO THIS FACILITY, ON HOW MANY DAYS DID YOU HAVE FIVE OR MORE DRINKS OF ALCOHOL IN A ROW, THAT IS, WITHIN A COUPLE OF HOURS?" Circle one answer.

QUESTION NUMBER TWENTY: "IF YOU HAVE EVER TRIED MARIJUANA, (pot, grass, etc), HOW OLD WERE YOU WHEN YOU TRIED IT FOR THE FIRST TIME?" CIRCLE ONE ANSWER.

QUESTION NUMBER TWENTY ONE: "DURING YOUR LIFE, HOW MANY TIMES, IF ANY, HAVE YOU USED MARIJUANA?" ("USED" MEANS TRYING IT MORE THAN ONCE). CIRCLE ONE ANSWER.

QUESTION NUMBER TWENTY TWO: "IF YOU HAVE EVER TRIED ANY FORM OF COCAINE, INCLUDING POWDER, CRACK, OR FREEBASE, HOW OLD WERE YOU WHEN YOU TRIED IT FOR THE FIRST TIME?" CIRCLE ONE ANSWER.

QUESTION NUMBER TWENTY THREE: "DURING YOUR LIFE, HOW MANY TIMES HAVE YOU USED ANY FORM OF COCAINE INCLUDING POWDER, CRACK, OR FREEBASE?" ("USED" MEANS TRYING IT MORE THAN ONCE). CIRCLE ONE ANSWER.

QUESTION NUMBER TWENTY FOUR: "DURING YOUR LIFE, HOW MANY TIMES HAVE YOU USED THE CRACK OR FREEBASE FORMS OF COCAINE?" (USED MEANS TRYING IT MORE THAN ONCE). CIRCLE ONE ANSWER.

QUESTION NUMBER TWENTY SIX: "DURING YOUR LIFE HAVE YOU EVER INJECTED (SHOT UP) ANY ILLEGAL DRUG?" (INCLUDING SKIN POPPING OR INJECTING STEROIDS). CIRCLE ONE ANSWER.

QUESTION NUMBER TWENTY SEVEN: "DO YOU HAVE A TATTOO?" (THIS MEANS A PERMANENT TATTOO). CIRCLE ONE ANSWER.

NOW TURN TO THE NEXT PAGE. FLIP THE SURVEY AND FIND THE PAGE WITH QUESTION NUMBER TWENTY EIGHT IN THE UPPER LEFT HAND CORNER. EVERYONE READY?

QUESTION NUMBER TWENTY EIGHT: "HOW OLD WERE YOU WHEN YOU GOT THE TATTOO?" (THIS MEANS A PERMANENT TATTOO). CIRCLE ONE ANSWER.

QUESTION TWENTY NINE: "HAVE YOU EVER BEEN TAUGHT ABOUT AIDS OR HIV INFECTION IN SCHOOL BY AN ADULT, EITHER IN THIS FACILITY OR ELSEWHERE?" CIRCLE ONE ANSWER.

QUESTION THIRTY: "DO YOU KNOW WHERE TO GET GOOD INFORMATION ABOUT AIDS OR HIV INFECTION? ("GOOD INFORMATION" MEANS ACCURATE AND USEFUL INFORMATION). CIRCLE ONE ANSWER.

QUESTION THIRTY ONE: "HAVE YOU EVER TALKED ABOUT AIDS OR HIV INFECTION WITH A PARENT OR OTHER ADULT OUTSIDE OF SCHOOL?" CIRCLE ONE ANSWER.

QUESTION THIRTY TWO: "CAN A PERSON GET AIDS OR HIV INFECTION FROM BEING BITTEN BY MOSQUITOES OR OTHER INSECTS?" CIRCLE ONE ANSWER.

QUESTION THIRTY THREE: "CAN A PERSON GET AIDS OR HIV INFECTION FROM DRINKING FROM THE SAME GLASS AS SOMEONE WHO ALREADY HAS AIDS OR HIV INFECTION?" CIRCLE ONE ANSWER.

QUESTION THIRTY FOUR: "HAVE YOU EVER WILLINGLY HAD SEX? WILLINGLY MEANS YOU WERE NOT FORCED." ("SEX" MEANS HAVING ANY KIND OF SEX WITH ANOTHER PERSON). CIRCLE ONE ANSWER.

QUESTION THIRTY FIVE: "HOW OLD WERE YOU THE FIRST TIME YOU WILLINGLY HAD SEX?" (WILLINGLY MEANS YOU WERE NOT FORCED). CIRCLE ONE ANSWER.

QUESTION THIRTY SIX: "IN YOUR ENTIRE LIFE, WITH HOW MANY DIFFERENT PERSONS HAVE YOU WILLINGLY HAD SEX?" CIRCLE ONE ANSWER.

QUESTION THIRTY SEVEN: "THE LAST TIME YOU WILLINGLY HAD SEX, DID YOU OR YOUR PARTNER USE A CONDOM?" (A CONDOM IS A RUBBER). CIRCLE ONE ANSWER.

QUESTION THIRTY EIGHT: "THE LAST TIME YOU WILLINGLY HAD SEX BEFORE COMING TO THIS FACILITY, DID YOU OR YOUR PARTNER DRINK ALCOHOL OR USE DRUGS BEFORE HAVING SEX?" CIRCLE ONE ANSWER.

OKAY, NOW TURN TO THE LAST PAGE. THIS LAST PAGE HAS QUESTION THIRTY-NINE IN THE UPPER LEFT HAND CORNER. IS EVERYONE READY?

QUESTION THIRTY NINE: "THE LAST TIME YOU WILLINGLY HAD SEX BEFORE COMING TO THIS FACILITY, WHAT METHOD DID YOU OR YOUR PARTNER USE TO PREVENT PREGNANCY." CIRCLE ONE ANSWER.

QUESTION FORTY ONE: "HAVE YOU EVER BEEN FORCED TO HAVE SEX (THAT IS, THROUGH ABUSE OR ASSAULT)?" CIRCLE ONE ANSWER.

QUESTION FORTY TWO: "HOW MANY TIMES HAVE YOU BEEN PREGNANT OR GOTTEN SOMEONE PREGNANT?" CIRCLE ONE ANSWER.

QUESTION FORTY FOUR: "WOULD YOU BE INTERESTED IN LEARNING MORE ABOUT HEALTH CARE FOR YOURSELF?" CIRCLE ONE ANSWER.

QUESTION FORTY FIVE AND THE LAST QUESTION: "WOULD YOU BE INTERESTED IN BEING INVOLVED IN THE DEVELOPMENT OF HEALTH EDUCATION PROGRAMS FOR OTHER PEOPLE YOUR AGE?" CIRCLE ONE ANSWER.

NOW TURN YOUR SURVEY BACK TO WHERE WE BEGAN. The Front page should be on top. With the survey laying on the surface in front of you. Put your pencils down.

Step Four: The Debriefing Stage:

(Read these instructions aloud to the students completing the survey).

"AS YOU LEAVE, YOU CAN PUT THE COMPLETED SURVEY IN THE BOX HERE. THEN THEY WILL BE SHIPPED OUT IMMEDIATELY TO THE UNIVERSITY THAT HAS REQUESTED THIS SURVEY."

"Before you leave, however, the University has asked that we remind you about a few things that came up in the survey."

"When the survey asked you about fighting, smoking, drinking, or drugs, in no way was it being implied that these types of behavior are acceptable or normal. These behaviors are health threats."

"As you know, we have counselors and even psychiatric help available if you ask for it. There is help available. You should always seek someone to talk to if you ever have any of these problems."

"As you probably know, you face a risk of being infected with the HIV virus if you ever shoot, mainline or even skinpop drugs. Because someone who was infected with the disease could have used the needle before you did."

"The truth is, you cannot become infected with the AIDS or HIV virus from mosquitos or insects. Nor form drinking from the same glass or eating off the same utensil as someone who is infected. That is not how the virus is spread. It is spread through unprotected sex and shooting up drugs."

"The University researchers want to thank each and every one of you for helping today with this national survey research project. They wish you the best in the future."

Step Five:

(You are ready to dismiss those students who have no questions.)

"Okay, everyone can leave now unless they could not answer one of the questions. If you needed help answering one of the questions, then you can remain seated and after everyone has left I will try to give you better instructions on how to complete the question properly."

"Please place your survey in one of the boxes. Also, the last person out will have to seal up the boxes in front of me."

"As you leave, place your survey in one of the boxes, and hand me the pencil as you leave."

STEP SIX:

(At this stage, all who remain are those with questions about the proper completion of the survey.)

(Have anyone who has not left remain in their seats).

"WHO HAS QUESTIONS? IF YOU HAVE A QUESTION RAISE YOUR HAND. DO NOT PICK UP YOUR PENCIL. I JUST WANT TO MAKE SURE NO ONE GOES BACK AND CHANGES THEIR ANSWERS ABOUT THE DRINKING GLASS AND THE MOSQUITOES, ETC. IF YOUR QUESTION WAS ABOUT THE MOSQUITOS OR DRINKING GLASS ONLY, THEN IT IS OKAY IF YOU JUST LEAVE THOSE TWO QUESTIONS BLANK. AND YOU CAN GO NOW."

(Note: Because we are suggesting that you do this one at a time, here is the chance to TRIAGE in terms of the efficiency of the process. Sometimes a student who is less serious about the process, who laughs, or feigns ignorance, etc, or who might stall the procedures, stays on anyhow. Deal with them first. Get them out so you can deal with those who may really need the help. This is always a judgement call based on what you know about the classroom behavior, demeanor, and ability of students. To repeat, to ease the process, you may want to not begin with your most compliant student, but with your most verbally aggressive, argumentative, types of students.)

"OKAY, OVER HERE (designate response to one person) WHAT QUESTION NUMBER ARE YOU UNSURE ABOUT? OPEN UP THE SURVEY AND TELL ME WHAT THE QUESTION NUMBER IS?"

(Respond again and clarify where possible).

"SO CIRCLE THE ANSWER THAT APPLIES TO YOU."

(Do this one at a time, until all students are out.)