Incarceration Data Research Articles

Buprenorphine dispensing in an epicenter of the U.S. opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky

BackgroundBuprenorphine is a cornerstone to curbing opioid epidemics, but emerging data suggest that rural pharmacists in the US sometimes refuse to dispense this medication. We conducted a case study to explore buprenorphine dispensing practices in 12 rural Appalachian Kentucky counties, and analyze whether and how they were shaped by features of the rural risk environment. MethodsIn this case study, we conducted one-on-one semi-structured interviews with 14 pharmacists operating 15 pharmacies in these counties to explore buprenorphine dispensing practices and perceived influences on these practices. Thematic analyses of the resulting transcripts revealed three features of the rural risk environment that shaped dispensing. To explore these three risk environment features, we analyzed policy documents (e.g., Attorney General lawsuits) and administrative databases (e.g., incarceration data). Textual documents were analyzed using thematic analyses and administrative data were analyzed using descriptive statistics; memoes explored relationships among risk environment features and dispensing practices. ResultsTwelve of the 15 pharmacies limited dispensing, by refusing to serve new patients; limiting dispensing to known patients or prescribers; or refusing to dispense buprenorphine altogether. Concerns about exceeding a “Drug Enforcement Administration (DEA) cap” on opioid dispensing stifled dispensing. A legacy of aggressive and fraudulent marketing of opioid analgesics (OAs) by pharmaceutical companies and physician OA overprescribing undermined pharmacist trust in buprenorphine and in its prescribers. The escalating local war on drugs may have undermined dispensing by reinforcing stigma against people who use drugs. ConclusionsInitiatives to increase buprenorphine prescribing must be accompanied by policy changes to increase dispensing. Specifically, buprenorphine should be removed from opioid monitoring systems; efforts to de-escalate the war on drugs should be extended to encompass rural areas; initiatives to dismantle aggressive OA marketing should be strengthened; and efforts to re-build pharmacist trust in physicians are needed.

Modeling the role of incarceration in HCV transmission and prevention amongst people who inject drugs in rural Kentucky

BackgroundPeople who inject drugs (PWID) experience high incarceration rates, with current/recent incarceration being associated with increased hepatitis C virus (HCV) transmission. We assess the contribution of incarceration to HCV transmission amongst PWID in Perry County (PC), Kentucky, USA, and the impact of scaling-up community and in-prison opioid substitution therapy (OST), including the potential for reducing incarceration.MethodsA dynamic model of incarceration and HCV transmission amongst PWID was calibrated in a Bayesian framework to epidemiological and incarceration data from PC, incorporating an empirically estimated 2.8-fold (95%CI: 1.36–5.77) elevated HCV acquisition risk amongst currently incarcerated or recently released (<6 months) PWID compared to other PWID. We projected the percentage of new HCV infections that would be prevented among PWID over 2020–2030 if incarceration no longer elevated HCV transmission risk, if needle and syringe programmes (NSP) and OST are scaled-up, and/or if drug use was decriminalized (incarceration/re-incarceration rates are halved) with 50% of PWID that would have been imprisoned being diverted onto OST. We assume OST reduces reincarceration by 10–42%.ResultsOver 2020–2030, removing the effect of incarceration on HCV transmission could prevent 42.7% (95% credibility interval: 15.0–67.4%) of new HCV infections amongst PWID. Conversely, scaling-up community OST and NSP to 50% coverage could prevent 28.5% (20.0–37.4%) of new infections, with this increasing to 32.7% (24.5–41.2%) if PWID are retained on OST upon incarceration, 36.4% (27.7–44.9%) if PWID initiate OST in prison, and 45.3% (35.9–54.1%) if PWID are retained on OST upon release. decriminalization (with diversion to OST) could further increase this impact, preventing 56.8% (45.3–64.5%) of new infections. The impact of these OST interventions decreases by 2.1–28.6% if OST does not reduce incarceration.ConclusionIncarceration is likely to be an important contributor to HCV transmission amongst PWID in PC. Prison-based OST could be an important intervention for reducing this risk.

Association of Restrictive Housing During Incarceration With Mortality After Release

Restrictive housing, otherwise known as solitary confinement, during incarceration is associated with poor health outcomes. To characterize the association of restrictive housing with reincarceration and mortality after release. This retrospective cohort study included 229 274 individuals who were incarcerated and released from the North Carolina prison system from January 2000 to December 2015. Incarceration data were matched with death records from January 2000 to December 2016. Covariates included age, number of prior incarcerations, type of conviction, mental health treatment recommended or received, number of days served in the most recent sentence, sex, and race. Data analysis was conducted from August 2018 to May 2019. Restrictive housing during incarceration. Mortality (all-cause, opioid overdose, homicide, and suicide) and reincarceration. From 2000 to 2015, 229 274 people (197 656 [86.2%] men; 92 677 [40.4%] white individuals; median [interquartile range (IQR)] age, 32 years [26-42]), were released 398 158 times from the state prison system in North Carolina. Those who spent time in restrictive housing had a median (IQR) age of 30 (24-38) years and a median (IQR) sentence length of 382 (180-1010) days; 84 272 (90.3%) were men, and 59 482 (63.7%) were nonwhite individuals. During 130 551 of 387 913 incarcerations (33.7%) people were placed in restrictive housing. Compared with individuals who were incarcerated and not placed in restrictive housing, those who spent any time in restrictive housing were more likely to die in the first year after release (hazard ratio [HR], 1.24; 95% CI 1.12-1.38), especially from suicide (HR, 1.78; 95% CI, 1.19-2.67) and homicide (HR, 1.54; 95% CI, 1.24-1.91). They were also more likely to die of an opioid overdose in the first 2 weeks after release (HR, 2.27; 95% CI, 1.16-4.43) and to become reincarcerated (HR, 2.16; 95% CI, 1.99-2.34). This study suggests that exposure to restrictive housing is associated with an increased risk of death during community reentry. These findings are important in the context of ongoing debates about the harms of restrictive housing, indicating a need to find alternatives to its use and flagging restrictive housing as an important risk factor during community reentry.

Protocol for the Data-Linkage Alcohol Cohort Study (DACS): investigating mortality, morbidity and offending among people with an alcohol-related problem using linked administrative data

IntroductionThe aims of this program of research are to use linked health and law enforcement data to describe individuals presenting to emergency and inpatient healthcare services with an acute alcohol...

Economic decline, incarceration, and mortality from drug use disorders in the USA between 1983 and 2014: an observational analysis

Drug use disorders are an increasing cause of disability and early death in the USA, with substantial geographical variation. We aimed to investigate the associations between economic decline, incarceration rates, and age-standardised mortality from drug use disorders at the county level in the USA. In this observational analysis, we examined age-standardised mortality data from the US National Vital Statistics System and the Institute for Health Metrics and Evaluation, household income data from the US Census Bureau, and county-level jail and prison incarceration data from the Vera Institute of Justice for 2640 US counties between 1983 and 2014. We also extracted data on county-level control variables from the US Census Bureau, the National Center for Health Statistics, and the US Centers for Disease Control and Prevention. We used a two-way fixed-effects panel regression to examine the association between reduced household income, incarceration, and mortality from drug use disorders within counties over time. To assess between-county variation, we used coarsened exact matching and a simulation-based modelling approach. After adjusting for key confounders, each 1 SD decrease in median household income was associated with an increase of 12·8% (95% CI 11·0-14·6; p<0·0001) in drug-related deaths within counties. Each 1 SD increase in jail and prison incarceration rates was associated with an increase of 1·5% (95% CI 1·0-2·0; p<0·0001) and 2·6% (2·1-3·1; p<0·0001) in drug-related mortality, respectively. The association between drug-related mortality and income and incarceration persisted after controlling for local opioid prescription rates. Our model accounts for a large proportion of within-county variation in mortality from drug use disorders (R2=0·975). Between counties, high rates of incarceration were associated with a more than 50% increase in drug-related deaths. Reduced household income and high incarceration rates are associated with poor health. The rapid expansion of the prison and jail population in the USA over the past four decades might have contributed to the increasing number of deaths from drug use disorders. None.

Evaluating strategies for control of tuberculosis in prisons and prevention of spillover into communities: An observational and modeling study from Brazil.

BackgroundIt has been hypothesized that prisons serve as amplifiers of general tuberculosis (TB) epidemics, but there is a paucity of data on this phenomenon and the potential population-level effects of prison-focused interventions. This study (1) quantifies the TB risk for prisoners as they traverse incarceration and release, (2) mathematically models the impact of prison-based interventions on TB burden in the general population, and (3) generalizes this model to a wide range of epidemiological contexts.Methods and findingsWe obtained individual-level incarceration data for all inmates (n = 42,925) and all reported TB cases (n = 5,643) in the Brazilian state of Mato Grosso do Sul from 2007 through 2013. We matched individuals between prisoner and TB databases and estimated the incidence of TB from the time of incarceration and the time of prison release using Cox proportional hazards models. We identified 130 new TB cases diagnosed during incarceration and 170 among individuals released from prison. During imprisonment, TB rates increased from 111 cases per 100,000 person-years at entry to a maximum of 1,303 per 100,000 person-years at 5.2 years. At release, TB incidence was 229 per 100,000 person-years, which declined to 42 per 100,000 person-years (the average TB incidence in Brazil) after 7 years. We used these data to populate a compartmental model of TB transmission and incarceration to evaluate the effects of various prison-based interventions on the incidence of TB among prisoners and the general population. Annual mass TB screening within Brazilian prisons would reduce TB incidence in prisons by 47.4% (95% Bayesian credible interval [BCI], 44.4%–52.5%) and in the general population by 19.4% (95% BCI 17.9%–24.2%). A generalized model demonstrates that prison-based interventions would have maximum effectiveness in reducing community incidence in populations with a high concentration of TB in prisons and greater degrees of mixing between ex-prisoners and community members. Study limitations include our focus on a single Brazilian state and our retrospective use of administrative databases.ConclusionsOur findings suggest that the prison environment, more so than the prison population itself, drives TB incidence, and targeted interventions within prisons could have a substantial effect on the broader TB epidemic.

Prosecutorial Discretion and Environmental Crime Redux: Charging Trends, Aggravating Factors, And Individual Outcome Data For 2005-2014

In a 2014 article entitled “Prosecutorial Discretion and Environmental Crime,” I presented empirical data developed by student researchers participating in the Environmental Crimes Project at the University of Michigan Law School. My 2014 article reported that 96 percent of defendants investigated by the United States Environmental Protection Agency and charged with federal environmental crimes from 2005 through 2010 engaged in conduct that involved at least one of the aggravating factors identified in my previous scholarship, namely significant harm, deceptive or misleading conduct, operating outside the regulatory system, and repetitive violations. On that basis, I concluded that prosecutors charged violations that included those aggravating factors in nearly every case over a six-year period—and that defendants who committed environmental violations that did not involve one of those aggravating factors were unlikely to face criminal charges. In this Article, I provide the latest data from the Environmental Crimes Project, which now includes defendants charged from 2005 through 2014. I again find that most defendants charged with federal environmental crimes committed violations that involved at least one of the four aggravating factors, with the levels even higher (98 percent of all defendants). I identify shifts in the data, the most notable of which are a dramatic drop in the number of cases and defendants charged during the last year of our data, a significant increase in the number of criminal charges brought under the Clean Air Act for non-asbestos abatement violations, and a nearly 40 percent increase in the percentage of defendants operating outside the regulatory system. I assess trends since Supreme Court decisions that restricted Clean Water Act jurisdiction and made federal sentencing guidelines advisory, and I analyze cases that fall outside my normative model and may pose questions about how prosecutors exercised their discretion. In addition, for the first time, I provide outcome data regarding environmental crime, which demonstrates that overall conviction rates are higher for environmental crime than in the federal system generally and for regulatory crime in particular, but are not as robust at trial. I also provide incarceration data, which shows that fewer environmental defendants are incarcerated than other regulatory crime defendants. I analyze whether there is any correlation between incarceration and the statutes charged, the presence of aggravating factors, or whether defendants plead guilty or are convicted after trial. The incarceration data shows a statistically significant correlation between the number of aggravating factors and whether a defendant is incarcerated. The incarceration data also shows a strong correlation between conviction at trial and incarceration, with defendants who are convicted at trial more than twice as likely to be sentenced to a period of incarceration than defendants who pleaded guilty.

Racial Disparity in U.S. Imprisonment Across States and Over Time

We analyze the contribution of changes in the black–white racial disparity in imprisonment to changes in the black incarceration rate. We also describe the behavior of the racial disparity across states and across time. We use state level incarceration data for non-Hispanic black and white males to perform a decomposition of the black incarceration rate. This allows us to attribute changes in black incarceration to changes in the racial disparity and changes in the overall incarceration rate. We use a Fourier approximation to identify structural change points for the racial disparity at both the state and national level. The large increase in black imprisonment between 1978 and 1999 was driven by increases in the overall rate of imprisonment, while the smaller decrease which occurred between 1999 and 2014 was driven by reductions in the black–white racial disparity. For many states, the racial disparity increased starting in the mid-1980s, where this increase may have been linked to the crack epidemic. Many states experienced a downturn in the racial disparity starting in the 1990s. Whatever its other effects, this suggests that the 1994 crime bill did not aggravate the preexisting racial disparity in imprisonment. California’s experience has been strongly counter to national trends with a large increase in the racial disparity beginning in the early 1990s and continuing until near the end of our sample. While the racial disparity in imprisonment has been falling since 1996, it remains quite high as of 2014. Future work is required to better understand the policy determinants of this disparity.

The Impact of School Nurses in Kentucky Public High Schools.

The purpose of this study was to examine the relationship between school nurse presence and graduation rates, absenteeism, and American College Test (ACT) scores. A state-wide survey of all public high schools was undertaken (participation rate of 99.1%). Survey data obtained from individual high schools provided information on the employment status of school nurses. In addition to nurse presence determined by the survey, open-access electronic databases were used to determine graduation rates, absenteeism, ACT scores, money spent per pupil, gender, race-ethnicity proportion, and incarceration data. Study findings showed a possible relationship between students attending schools with a full-time nurse and significantly higher graduation rates, lower absenteeism, and higher ACT scores. The study results suggest that school nurses may contribute not just to health outcomes but to improved academic and economic outcomes as well. Of course, future work is needed to confirm these assertions.

Parental Incarceration and Child Health in the United States.

Mass incarceration has profoundly restructured the life courses of not only marginalized adult men for whom this event is now so prevalent but also their families. We examined research published from 2000 to 2017 on the consequences of parental incarceration for child health in the United States. In addition to focusing on specific health outcomes, we also considered broader indicators of child well-being because there has been little research on the association between parental incarceration and objectively measured child health outcomes. Our findings support 4 conclusions. First, paternal incarceration is negatively associated-possibly causally so-with a range of child health and well-being indicators. Second, although some research has suggested a negative association between maternal incarceration and child health, the evidence on this front is mixed. Third, although the evidence for average effects of paternal incarceration on child health and well-being is strong, research has also suggested that some key factors moderate the association between paternal incarceration and child health and well-being. Finally, because of the unequal concentration of parental incarceration and the negative consequences this event has for children, mass incarceration has increased both intracountry inequality in child health in the United States and intercountry inequality in child health between the United States and other developed democracies. In light of these important findings, investment in data infrastructure-with emphasis on data sets that include reliable measures of parental incarceration and child health and data sets that facilitate causal inferences-is needed to understand the child health effects of parental incarceration.

Hanging Out With the Usual Suspects: Neighborhood Peer Effects and Recidivism

Social interactions within neighborhoods, schools and detention facilities are important determinants of criminal behavior. However, little is known about the degree to which neighborhood peers affect successful community re-entry following incarceration. This paper measures the influence of pre-incarceration social networks on recidivism by exploiting the fact that peers may be locked up when a prisoner returns home. Using detailed arrest and incarceration data that includes residential addresses for offenders, we find consistent and robust evidence that a former inmate is less likely to reoffend if more of his peers are held captive while he reintegrates into society.

Systematic Assessment of Linkage to Care for Persons with HIV Released from Corrections Facilities Using Existing Datasets.

Populations in corrections continue to have high prevalence of HIV. Expanded testing and treatment programs allow persons to be identified and stabilized on treatment while incarcerated. However, these gains and frequently lost on reentry. Systemic frameworks are needed to monitor linkage to care to guide programs supporting linkage to care. To assess the adequacy of linkage to care on reentry, incarceration data from the National Corrections Reporting Program and data from the Ryan White Services Report from 2010 to 2012 were linked using an encrypted client identification (eUCI). Time from release to the first visit and presence of detectable HIV RNA at linkage were assessed. Multivariate survival analyses were performed to identify associations between patient characteristics and time to linkage. Among those linking, only 43% in Rhode Island and 49% in North Carolina linked within 90 days, and 33% in both states had detectable viremia at the first visit. Those not previously in care and with shorter incarceration experiences longer linkage times. Persons identified as black, had median times greater than 1 year. Using existing datasets, significant gaps in linkage to care for persons with HIV on release from corrections were demonstrated in Rhode Island and North Carolina. Systemically implementing this monitoring to evaluate changes over time would provide important information to support interventions to improve linkage in high-risk populations. Using national datasets for both corrections and clinical data, this framework equally could be used to evaluate experiences of persons with HIV linking to care on release from corrections facilities nationwide.

The Effects of Youth Employment: Evidence from New York City Lotteries *

Abstract Programs to encourage labor market activity among youth, including public employment programs and wage subsidies like the Work Opportunity Tax Credit, can be supported by three broad rationales. They may (i) provide contemporaneous income support to participants; (ii) encourage work experience that improves future employment and/or educational outcomes of participants; and/or (iii) keep participants “out of trouble.” We study randomized lotteries for access to the New York City (NYC) Summer Youth Employment Program (SYEP), the largest summer youth employment program in the United States, by merging SYEP administrative data on 294,100 lottery participants to IRS data on the universe of U.S. tax records; to New York State administrative incarceration data; and to NYC administrative cause of death data. In assessing the three rationales, we find that (i) SYEP participation causes average earnings and the probability of employment to increase in the year of program participation, with modest contemporaneous crowdout of other earnings and employment; (ii) SYEP participation causes a modest decrease in average earnings for three years following the program and has no impact on college enrollment; and (iii) SYEP participation decreases the probability of incarceration and decreases the probability of mortality, which has important and potentially pivotal implications for analyzing the net benefits of the program.

What Can Be Learned from Cross-National Comparisons of Data on Illegal Drugs?

There has been relatively little effort at cross-national analysis of data concerning drug policy, though there is growing variation in how nations deal with illegal drugs. Systematic accounts of barriers to, and opportunities for, making comparisons are scarce. Comparisons of drug use prevalence, the focus of most cross-national studies, are undermined by fundamental and unacknowledged methodological differences. Prevalence is a poor measure of drug problems, but more appropriate indicators, such as drug-related crime and morality, are generated by institutional and legal systems that differ across countries, making them even more difficult to compare. The same is true of intensity of enforcement; besides problems of creating comparable arrest, conviction, and incarceration data, there is difficulty in generating an appropriate denominator of offenses. Collaboration among national data collection programs can help somewhat, but substantial progress will depend on harmonization of basic measurement systems, such as arrests and incarceration and on more subtle measures such as the prevalence of problem drug use

Male Incarceration Rates and Rates of Sexually Transmitted Infections: Results From a Longitudinal Analysis in a Southeastern US City.

In the United States, rates of certain sexually transmitted infections (STIs) are increasing. Contextual factors seem to play an important role in shaping STI transmission dynamics. This longitudinal study explores the relationship between one contextual determinant of health (the male incarceration rate) and rates of newly diagnosed STIs in census tracts in Atlanta, GA. The sample consisted of all census tracts in Atlanta (n = 946). Annual data on STI diagnoses were drawn from the Georgia surveillance system for 2005 to 2010; annual male incarceration data were drawn from the Georgia Department of Corrections for 2005 to 2010; and data on potential confounders were drawn from the US Census. Multivariable growth models were used to examine the association between the male incarceration rate and rates of newly diagnosed STIs, controlling for covariates. Census tracts with higher baseline male incarceration rates had a higher baseline rate of newly diagnosed STIs. Census tracts with increasing male incarceration rates experienced a more rapid increase in their rate of newly diagnosed STIs. Census tracts with medium and high baseline male incarceration rates experienced a decrease in their rate of newly diagnosed STIs over time. The present study strengthens the evidence that male incarceration rates have negative consequences on sexual health outcomes, although the relationship may be more nuanced than originally thought. Future multilevel research should explore individual sexual risk behaviors and networks in the context of high male incarceration rates to better understand how male incarceration shapes rates of STIs.

Cognitive bias modification combined with cognitive behavioral therapy: A smoking cessation intervention for adolescents

Aims: To describe deaths in prison in a cohort of opioiddependent people, and examine associations between receipt of opioid substitution therapy (OST) and risk of death while in prison. Methods: We linked state-wide OST data to incarceration and mortality data. We calculated crude mortality rates (CMR) for allcause and unnatural (suicide, drug-induced, violent and injury) deaths in prison, and used Cox regression to assess adjusted associations between death and receipt of OST. Rates and hazard ratios were calculated for the entirety of time in prison, and for the first four weeks in prison. Results: The cohort comprised 16,715 opioid-dependent people who had been incarcerated. Fifty-one people died in prison. Compared to periods of time in OST, all-cause and unnatural mortality rateswere significantly higherwhile not in OST (all-cause rate ratio (RR): 4.1; 95% confidence interval (CI): 2.1, 8.0; unnatural death RR: 6.7; 95% CI: 2.6, 17.3). Compared to time out of OST, the hazard of all-cause deathwas 74% lowerwhile in OST (adjusted hazard ratio (AHR): 0.26; 95% CI: 0.13, 0.50), and the hazard of unnatural death was 87% lower while in OST (AHR: 0.13; 95% CI: 0.05, 0.35). In the first fourweeks of incarceration, compared to periods in OST, all-cause mortality was 16.6 (95% CI: 2.2, 124.9) times higher, and unnaturalmortalitywas14.0 (95%CI: 1.8, 107.9) timeshigherwhen not in OST. Compared to periods not in OST, the hazard of all-cause death during the first 4weeks of incarcerationwas 94% lowerwhile in OST (AHR: 0.06; 95% CI: 0.01, 0.48), and the hazard of unnatural death was 93% lower while in OST (AHR: 0.07; 95% CI: 0.01, 0.53). Conclusions: Ensuring a high coverage of OST in correctional facilities will help to minimize deaths, particularly unnatural deaths, among opioid-dependent prisoners. Timely access to OST while incarcerated is critical to realizing this benefit. Financial Support:NationalHealthandMedicalResearchCouncil.

The contagious nature of imprisonment: an agent-based model to explain racial disparities in incarceration rates.

We build an agent-based model of incarceration based on the susceptible–infected–suspectible (SIS) model of infectious disease propagation. Our central hypothesis is that the observed racial disparities in incarceration rates between Black and White Americans can be explained as the result of differential sentencing between the two demographic groups. We demonstrate that if incarceration can be spread through a social influence network, then even relatively small differences in sentencing can result in large disparities in incarceration rates. Controlling for effects of transmissibility, susceptibility and influence network structure, our model reproduces the observed large disparities in incarceration rates given the differences in sentence lengths for White and Black drug offenders in the USA without extensive parameter tuning. We further establish the suitability of the SIS model as applied to incarceration by demonstrating that the observed structural patterns of recidivism are an emergent property of the model. In fact, our model shows a remarkably close correspondence with California incarceration data. This work advances efforts to combine the theories and methods of epidemiology and criminology.

Striking subgroup differences in substance-related mortality after release from prison.

To compare the incidence, timing and risk factors for substance-related death between Indigenous and non-Indigenous ex-prisoners in Queensland, Australia. Retrospective cohort study. All adult prisons in the state of Queensland, Australia, linked to deaths registered in Australia. We obtained records for all adults released from prison in Queensland, Australia from 1 January 1994 to 31 December 2007. Among this cohort of 42 015 individuals we observed 82 315 releases from prison and 2158 deaths in the community by the end of 2007, of which 661 were substance-related deaths. Incarceration data were obtained from Queensland Corrective Services and linked probabilistically with deaths recorded in the Australian National Death Index. In the first year after release, Indigenous ex-prisoners were more likely to die from alcohol-related causes [hazard ratio (HR) = 1.9, 95% confidence interval (CI) = 1.1-3.1)] but less likely to die of drug-related causes (HR = 0.34, 95%CI = 0.21-0.53) than were non-Indigenous ex-prisoners. Among non-Indigenous prisoners only, the risk of substance-related death was significantly higher in the first 4 weeks [relative risk (RR) = 5.1, 95% CI = 3.7-6.9] when compared with the risk after 1 year post-release. Most evaluated risk factors for substance-related death were similar for Indigenous and non-Indigenous ex-prisoners; however, the hazard of death increased with age more for Indigenous ex-prisoners (HR = 1.7 per decade of age, 95% CI = 1.4-2.1) than for non-Indigenous ex-prisoners (HR = 1.3, 95% CI = 1.2-1.4). In Australia, patterns of substance-related death in ex-prisoners differ markedly according to Indigenous status. Efforts to prevent substance-related deaths in ex-prisoners should consider heterogeneity in the target population and tailor responses accordingly.

Intergenerational offending: an analysis of families in jail

The current study seeks to identify and describe low-risk, medium-risk, and high-risk families within a county jail in Pennsylvania. Using official incarceration data, a subsample of individuals admitted to the jail during September to December 2009 were selected as study participants. Next, 20 years of official incarceration data from 1990–2009 were searched in an effort to identify family members of study participants to determine the level of risk for each identified family. It was hypothesized and found that a small percentage of families would account for a large percentage of jail admissions. A discussion of the financial and social costs of high-risk families to county system resources and communities is provided.

Long-term prevention of criminality in siblings of serious and violent juvenile offenders: A 25-year follow-up to a randomized clinical trial of multisystemic therapy.

Family-based treatment models that have shown effectiveness with juvenile offenders may also lead to reduced criminality in siblings of those offenders. However, the lasting effects of such treatments on siblings have not been evaluated. In the present study, the authors examined criminal outcomes for siblings of serious and violent juvenile offenders who had participated on average 25.0 years earlier in a clinical trial of multisystemic therapy (MST; Borduin et al., 1995). Participants were 129 closest-in-age siblings of individuals who were originally randomized to MST or individual therapy (IT) during adolescence. Arrest and incarceration data were obtained in middle adulthood when siblings were on average 38.4 years old. Intent-to-treat analyses showed that arrest rates were significantly lower for siblings in the MST condition than in the IT condition (43.3% vs. 72.0%, respectively). In addition, siblings in the IT condition were about 3 times as likely to be convicted of a felony and more than twice as likely to be sentenced to incarceration and probation. The present study represents the longest follow-up to date of sibling participants in an MST clinical trial and demonstrates that the positive impact of an evidence-based treatment for serious and violent juvenile offenders can extend to other family members. Implications of the authors' findings for policymakers and service providers are discussed.