Following the theory-based approach of Carter-Pokras and Baquet  guiding the evaluation and deconstruction of racial/ethnic differences in the field of health, this preliminary study sought to evaluate the existence of racial/ethnic differences among justice-involved youth by examining the recommended three contributing factors: (1) relative representation in a system of justice (juvenile probation), (2) relative rates of substance use (alcohol, tobacco, marijuana, and other illicit hard drug use), and (3) the relationships between a set of individual-level risk factors (school involvement, employment, self-esteem, and level of externalizing behaviors) and substance use across racial/ethnic groups.
More specifically, in this study, we found support for Hypothesis 1, the over-representation of racial/ethnic minority youth in the juvenile justice system. In contrast to recent surveys , this sample contained a disproportionate representation of racial/ethnic minority youth . Specifically, as compared to the participating metropolitan area, there were twice as many Hispanic youth, six times as many African American youth, ten times as many AIAN youth, and only one-fifth as many Caucasian youth as would be expected .
For Hypothesis 2 we posited that justice-involved Caucasian youth would evidence greater substance use rates than racial/ethnic minority youth. This hypothesis was supported, as Caucasian adolescents evidenced the greatest rates across almost all substance use categories. In contrast to the broader adolescent literature which found the greatest levels of use among AIAN and Hispanic youth [18–20], these findings are consistent with other literature sampling justice involved youth [e.g., . In terms of other racial/ethnic differences, African American adolescents demonstrated the lowest rates of use, and AIAN and Hispanic youth generally fell in between those two groups. Together, these data support that despite their respective underrepresentation in the justice system, justice-involved Caucasian adolescents may have much greater rates of substance use than adolescents of other racial/ethnic groups [e.g., [25–28]].
In terms of Hypothesis 3, as the level of substance use in this sample was significant enough to potentially influence these youths' later health outcomes , we examined individual-level risk factors that could predict substance use. Specifically, we evaluated whether these risk factors were more effective in predicting substance use for Caucasian versus racial/ethnic minority youth. Consistent with prior studies that have found that Caucasian youth may be more severe in terms of psychopathology [e.g., , we found that comparatively, Caucasian youth evidenced the greatest risk. In addition, African American youth evidenced the lowest risk, and AIAN and Hispanic youth fell between Caucasian and African-American youth. Specifically, Caucasian youth had higher externalizing behavior scores than African American or Hispanic youth, as well as significantly lower levels of self-esteem than African American youth. Contrary to predictions, a racial/ethnic group by risk factor finding emerged for only one risk factor and one substance use category; externalizing behavior was a significant correlate of hard drug use for Caucasian youth, but showed no relationship to hard drug use for African American youth. These data indicate that, with respect to Hypothesis 3, that the frequently employed individual-level risk factors were less useful in flagging potential points of concern for the high risk youth of this sample, particularly for African American youth.
While not predicted, the most profound differences emerged between African American and Caucasian youth. One potential explanation for this difference is that more protective factors may exist in our society to prevent Caucasian youth's justice involvement. For example, while not explicitly examined in this study, studies have suggested that high-risk and substance-abusing Caucasian youth may be "referred" to hospitals, medical care, and treatment, whereas African American and other racial/ethnic minority youth are alternatively "referred" to justice settings . Additionally, as found with other studies, African American youth in this sample had the lowest level of overall substance use [e.g., , but were disproportionately represented in this sample. These findings indicate the need for better prevention of justice involvement, as well as better indicators of what might be points of risk (e.g., measurements of potential individual-level risk factors) for African American youth.
Together, these data indicate support for two of the three points of evaluation recommended by Carter-Pokras and Baquet . To that end, these findings support the existence of racial/ethnic differences in the relative representation and patterns of substance use of justice-involved adolescents. Additionally, these data suggest that the current empirically-supported avenues to identify youth who might be at-risk for abusing substances (e.g., measurements of individual level risk factors) may be less effective for indicating the need for intervention among justice-involved youth, and particularly among racial/ethnic minority youth within this context. This is highly relevant, as racial/ethnic minority youth have been found to evidence greater functional impairment in the years following justice involvement . Together, these data indicate the importance of continuing to identify and evaluate risk factors for justice-involved and racial/ethnic minority youth, as well as the need to adapt and/or create measurement approaches to effectively evaluate these constructs among justice-involved minority youth. Finally, consonant with the theoretical approach of Carter-Pokras and Baquet , an important next step to follow this preliminary study is to evaluate whether or not the observed racial/ethnic differences are avoidable and unfair; this is key to determining the existence of inequity.
In terms of clinical implications, to effectively address the diverse health needs of youth entering the justice system, these findings highlight the need for timely, developmentally-, and culturally-appropriate substance abuse interventions to all youth entering the justice system [e.g., . One brief intervention which has shown promise in high-risk youth and cross-cultural applications is motivational interviewing [e.g., . Similarly, as the picture of health needs that these youth may face may be more complex than what might be addressable within the justice system, these data also suggest that comprehensive, multi-level services, such as the Wrap-around work pioneered by Karl Dennis [e.g., , might be uniquely able to address the differing, but equally important needs of these high-risk youth. Finally, in terms of potential avenues for prevention, these data highlight the importance of determining where differences (and potential inequities) may begin in order to guide more effective prevention programming for these high-need youth. Specifically, if there are indeed differences in the relative rates of referral , it will be important to determine the level at which the differential referral may be taking place (e.g., community mental health providers, social service agencies, schools, local law enforcement agencies), to guide public policy and educational programming changes. Furthermore, while many research groups (including our own) are actively evaluating health risk trajectories and outcomes among high-risk youth (Bryan, Schmiege, Magnan: Marijuana use and risky sexual behavior among high risk adolescents: Trajectories, risk factors, and event-level relationships, submitted; Feldstein Ewing, Schmiege, Bryan: Continued detention involvement and adolescent marijuana use trajectories, submitted), greater attention needs to be paid to the front end of this continuum. In particular, research needs to continue to explicitly evaluate contributing factors and patterns of substance use with high-risk racial/ethnic minority youth to identify places to most effectively target prevention and intervention approaches. This important work will help highlight how to tailor and implement prevention approaches with high-risk youth in order to improve youth's long-term health outcomes .