Evidencing the Need to Screen for Social Determinants of Health Among Boys Entering a Juvenile Prison: A Latent Profile Analysis

AuthorKelli R. Thompson,Noel Vest,Rebecca L. Fix
Published date01 July 2022
Date01 July 2022
Subject MatterArticles
Youth Violence and Juvenile Justice
2022, Vol. 20(3) 187205
© The Author(s) 2022
Article reuse guidelines:
DOI: 10.1177/15412040221096359
Evidencing the Need to Screen
for Social Determinants of
Health Among Boys Entering a
Juvenile Prison: A Latent Prof‌ile
Rebecca L. Fix, PhD
, Noel Vest, PhD
, and Kelli R. Thompson, PhD
Social determinants of health inf‌luence who ends up in the juvenile legal system and how in-
dividuals fare when entering and leaving the system. The present study utilized latent prof‌ile
analysis to determine the extent to which social determinants of health were present in a sample
of incarcerated youth and the patterns in which they appear. The authors then examined their
relationships to racial groups, depression, substance misuse, and recidivism risk. Data were from
1288 adolescent boys sentenced to a juvenile prison in one Southeastern state for serious of-
fending (i.e., repeat offenses, offenses involving physical or sexual violence). We ran a latent class
analysis to test for patterns with which youth present with various social determinants of health.
Prof‌iles with more violence exposure and higher social support were comprised of more Black
boys than the referent prof‌ile. Property and sexual offenses also differed signif‌icantly from the
referent prof‌ile. Altogether, results from our examination of selected social determinants of
health indicated such factors meaningfully contribute to our understanding of experiences of
young people in the juvenile legal system and may be targets for mental health and substance use
intervention as they may contribute to problem behaviors or negative outcomes.
risk assessment, latent prof‌ile analysis, race, juvenile justice, residential care
Transition into and out of residential care within the juvenile legal system particularly juvenile
prisons is stressful for young people and their families and is a major risk factor for other mental,
Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
Stanford University School of Medicine, Stanford, CA, USA
Auburn University Department of Psychological Sciences, Auburn, AL, USA
Corresponding Author:
Rebecca L. Fix, PhD, Johns Hopkins University, Bloomberg School of Public Health, 415 N. Washington Street,
Baltimore, MD 21231, USA.
Email: rebecca.f‌ix@jhu.edu
behavioral, and physical health problems (Abrahams et al., 2020;Montoya-Barthelemy et al.,
2020;Teplin et al., 2002). These resultant mental and behavioral risk factors are an important
focus for reducing recidivism among adolescents in residential settings (Aebi et al., 2021;
Baglivio et al., 2018;Yoder et al., 2017). More importantly, socioecological frameworks remind
us that these risk factors often occur at multiple levels, such as social, family, and community
levels, not just the individual level (Bronfenbrenner, 1994). Yet, we attend little to these soci-
oecological needs, which often occur outside the purview of the prison, to promote successful
reentry. To inform care for this vulnerable clinical population, this study aimed to determine if
relevant subgroups exist based upon important socioecological factors.
Social Determinants of Adolescent Health in the Juvenile Legal System
Social determinants of health (SDH) include the psychosocial, physical, and economic conditions
within a society that meaningfully inf‌luence health, broadly encompassing the conditions in
which people are born, grow, live, work and age(World Health Organization, 2021). The Centers
for Disease Control and Prevention (2021) identif‌ied several domains of SDH that broadly affect
individual risk and outcomes including: economic stability, access to and quality of healthcare and
education systems, social and community contexts, and the connection between ones neigh-
borhood and housing environments. SDH likely impact many mental and behavioral health
symptoms, as well as outcomes such as recidivism, observed among young people in residential
treatment facilities (Caruso, 2017). Yet, there is a paucity of comprehensive research on how these
SDH impact presenting needs and concurrent outcomes among adolescents in the juvenile legal
system. A better understanding would provide administrators, healthcare professionals, and
researchers with valuable information for public health planning among this extremely vulnerable
adolescent population. More specif‌ically, perhaps the most relevant social determinants for young
people involved in the juvenile legal system include violence exposure across systems including
school, home, and neighborhood contexts, and social support through family and peer attachment
(Fix et al., 2017;Fix & Burkhart, 2015;Yoder et al., 2018). The presence of negative or noxious
stimuli especially direct and indirect victimization in homes, schools, and communities may
uniquely contribute to delinquent behavior among young people (see Baek et al., 2018;Eitle &
Eitle, 2016;Lin & Yi, 2013;Lopez et al., 2018). Black young people are the greatest risk for
violence exposure and for experiencing multiple forms of childhood violence exposure (Sheats
et al., 2018). Such experiences also contribute to mental health sequelae (e.g., (Bordin et al., 2022;
Brunstein Klomek et al., 2019)). Childhood and adolescent exposure to violence across home,
school, and community or neighborhood contexts ref‌lects a particularly pernicious and salient
SDH among young people in the juvenile legal system. A critical review of the literature published
by Fix and Burkhart (2015) further highlighted the need for examination of exposure to violence
across multiple contexts simultaneously instead of in isolation.
Family violence exposure/violence exposure in the home setting primarily consists of wit-
nessed or experienced child physical abuse and intimate partner violence. Childhood and ado-
lescent exposure to violence in the home is associated with greater likelihood of aggression during
adolescence (Bordin et al., 2022;Fagan, 2020). Additionally, in one study of imprisoned young
people, research has demonstrated a signif‌icant association between family violence exposure and
depression and substance use, which in turn contribute to f‌ighting while incarcerated (Fix et al.,
2017). The association between family violence exposure and substance use was more pro-
nounced for White boys compared with Black boys. Altogether, this work points to a need to
examine the role of the home ecosystem among young people who have become involved in the
juvenile legal system and to consider the impact of race in such research work.
188 Youth Violence and Juvenile Justice 20(3)

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