Evidence Briefs: Public Health Topics
Violence Prevention
The Problem:
Sexual abuse is a big public health problem. Every year, there are about 90,000 rapes. U.S. Department of Justice, Federal Bureau of Investigation. Victims of sexual abuse suffer extensive physical and emotional harms; the long term sequelae of sexual abuse are associated with a number of health risk factors later in life. Beitchman et al, A Review of the Long-term Effects of Child Sexual Abuse, Child Abuse & Neglect 1992; 16(1): 101-118. A significant portion of sexual crimes are committed by juveniles; research indicates that as much as 80% of adult sexual offenders committed sexual crimes as juveniles. Groth et al, Undetected recidivism among rapists, and child molesters. Crime and Delinquency, 1982; 128: 450-458. This suggests that treatment and rehabilitation of juvenile sexual offenders (JSOs) is important to reducing sexual violence. In 2008, 14,500 children were arrested for sexual offenses not including rape; 3340 children were arrested for rape. U.S. Department of Justice, Office of Juvenile Justice0. Rehabilitation is the primary aim of juvenile criminal justice systems in the United States. However, high rates of recidivism in sexual crimes and the high proportion of sexual crimes committed between juvenile family members challenge policies that otherwise seek to minimize the time that juvenile offenders spend in correctional custody. In this context, JSOs often fail to receive treatment addressing the bio-psychosocial causes of offending.
The Law:
Mandatory treatment is often required as a condition of adjudications or plea bargains for juveniles charged with sexual crimes. The court system presents, in this respect, an important source of leverage for forcing sexual offenders into treatment. Probation and sentencing contingencies may be used to increase compliance with mandated treatment. All judges have discretionary authority to order participation in treatment programs for minors in adjudications involving sexual crimes. Some states mandate treatment in specialized programs for juvenile sexual offenders (Kentucky, KRS 635.515 (1), Alabama, Ala. Code 15-20-27).
The Evidence:
Reiztel and Carbonell conducted a systematic review and meta-analysis of studies evaluating the effectiveness of juvenile sexual offender treatment programs. Lorraine R. Reitzel and Joyce L. Carbonell, The Effectiveness of Sexual Offender Treatment for Juveniles as Measured by Recidivism: A Meta-analysis, Sex Abuse (2006) 18:401–421. Only studies comparing recidivism among groups receiving and not receiving treatment were included; random placement into treatment and control groups was not required. Nine studies satisfied the inclusion criteria. Using a fixed effects meta-analysis of odds ratios across the studies, the reviewers found a statistically significant 0.43 effect size suggesting a sizable protective relationship between treatment and recidivism: for every 43 offenders in the treatment group that recidivate, 100 in the control group do so. Simple un-weighted average recidivism rates between the treatment group (7.37%) and the control group (18.93%) were substantially different. Though cautioning that the treated and untreated groups may have varied in systematic ways, the authors viewed the nine studies as sufficient evidence to conclude that treatment is effective in reducing recidivism.
The Bottom Line:
According to the authors of a peer-reviewed meta-analysis, there is sufficient evidence to support the effectiveness of laws requiring treatment for juvenile sexual offenders in reducing recidivism.
The Problem:
Violence is a major public health problem. There were more than 5 million violent crimes in 2007, including 248,280 sexual assaults and 597,320 robberies. USDOJ: Criminal Victimization in the United States, 2007. There were 16,272 deaths from murder or non-negligent manslaughter in 2008. U.S. Bureau of Justice Statistics. In addition to directly causing acute injuries, emotional harm, and deaths, crime may undermine population health through indirect mechanisms. For example, high rates of crime make outdoor exercise unsafe, contributing to lower levels of physical activity. Crime also adds to the burden of stress for people living in high crime areas.
The Law:
The law prohibits violent crime, but implementation varies. “Hot spot policing” is a law enforcement strategy that focuses limited police resources on street corners, alleys or other places in a neighborhood where crime is particularly prevalent. For more information on hot spot policing, see U.S. Dept of Justice: Hot Spot Policing.
The Evidence:
Braga systematically reviewed nine studies that assess the impact of hot spot policing on crime. Braga. The effects of hot spots policing on crime. Campbell Systematic Review 2007:1. The studies evaluated three types of hot spot policing interventions: (1) enforcement of problem-oriented policing interventions; (2) directed and aggressive patrol programs; and (3) police crackdowns and raids. Of the nine studies, five employed randomized experimental designs and four employed quasi-experimental designs. Seven of the nine studies found hot spot policing to be associated with reductions in crime and disorder. A meta-analysis conducted on the five randomized studies found a statistically significant 67 percent reduction in reported calls for police assistance. There was not enough evidence to determine the relative effectiveness of the three different intervention types. Displacement of crime – a concern with hot spot policing – was examined in five of the studies. None of the studies observed a substantial displacement effect. However, Braga and the authors of the underlying studies caution that displacement is a difficult phenomenon to measure and that more sophisticated measures may be needed to fully assess whether displacement occurs. Braga interpreted the results of the meta-analysis of the five studies and the evidence in all nine studies collectively as “fairly robust evidence that hot spots policing is an effective crime prevention strategy.”
The Bottom Line:
According to the author of a Campbell Collaboration systematic review and meta-analysis, the current evidence supports the effectiveness of hot spots policing as a crime prevention strategy.
The Problem:
The maltreatment of children is a tragically common occurrence in the United States with a devastating impact on the health of young Americans. The direct effects of child maltreatment for victims include injuries and a host of stress-induced harms including poor psychological health, obesity, eating disorders and suicide. Child maltreatment also indirectly harms public health by creating generational cycles of abuse; a significant portion of victims of child abuse become child abusers. In 2007, there were 3.2 million cases of child abuse in the U.S. Centers for Disease Control: Child Maltreatment Fact Sheet. While primary prevention strategies focus on identifying risk factors to stop child abuse before it occurs, establishing secondary prevention methods to limit the harms of abuse is also of great importance.
The Law:
Kinship care is a legal arrangement in which a child welfare agency places a maltreated child under the direct care of a family member or family friend with a suitably extensive pre-existing relationship with the child. The Personal Responsibility and Work Opportunity Reconciliation Act (1996) required states to give preference to family members when placing a child outside the home. 42 U.S.C. 671(a)(19). More recently, the Adoption and Safe Families Act (1997) reaffirmed the federal commitment and support for kinship care. Although states have adopted slightly different definitions of family and kin, kinship care is widely preferred among jurisdictions. For examples of kinship laws, see CA Welf. & Inst. Code § 361.3 (California) and CO Rev. Stat. §§ 19-3-508; 19-3-605 (Colorado).
The Evidence:
In a study sponsored by the Campbell Collaborative and also published in the Cochrane Guide database, Winokour et al. performed a meta-analysis on 62 studies that evaluated the well-being of children placed in formal kinship care versus those placed in traditional foster homes. Winokour et al. Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment. The Campbell Collaboration. January 2009. Their analyses showed that children in kinship care have better mental health functioning, behavioral development and placement stability than children in non-kinship care. No differences were found in the rate of reunification with biological parents or in educational attainment. Children in non-kinship care also accessed mental health services and support groups slightly more than kinship care children, though it is unclear, according to Winokour et al., whether this benefit was the result of need or accessibility.
The Bottom Line:
According to a systematic review and meta-analysis sponsored by the Campbell Collaboration, kinship care placement produces better outcomes than non-kinship care for children that have been subject to maltreatment at home.
Additional Information:
The Children’s Bureau of the U.S. Department of Health and Human Services has compiled a guide on state kinship laws: Placement of Children with Relatives: Summary of State Laws.
Publication Date: 12/07/2009
The Problem:
The shortage of adequate, affordable housing can create pockets of concentrated poverty, exposing children and others to lead and other pathogens, which affects the health of children and families. The Urban Institute. Research on Record: Housing. Also, housing expenses draw resources away from health expenditures (e.g., nutritious food and healthcare). CDC and U.S. Department of Housing and Urban Development. Healthy Housing Reference Manual.
The Law:
States and localities have attempted to address the inadequate supply of affordable housing and its associated harms by facilitating the creation of mixed income housing developments through a number of legal mechanisms. Mixed-income housing developments provide affordable housing for low-income residents in rental units that are interspersed with market-rate housing. Laws promote mixed-income housing developments by subsidizing the construction of multi-family residences and reserving a portion of units for low-income residents at affordable prices. Hope VI is federal housing program that funds mixed-income housing fully or in partnership with private developers. HOPE VI Revitalization Notices of Funds Availability; 24 C.F.R. 941.600. Some municipalities have used zoning law to increase mixed income housing. For example, Sacramento, Calif. ( Sacramento City Code § 17.190.030) and Burlington, Vt. (Burlington Comprehensive Zoning Ordinance §§ 9.1-9.2)) have inclusionary zoning requirements that require that a certain percentage of new housing units are affordable to low-income residents.
The Evidence:
In a Community Guide review, Anderson et. al. could not find any qualifying studies that measured the impact of mixed-income housing developments in creating and maintaining safe and affordable housing for low-income residents. Anderson LM, et al. Providing affordable family housing and reducing residential segregation by income: a systematic review. Am J Prev Med. 2003;24(3S):S47-67. As a result, the reviewers could not ascertain the effectiveness of mixed-income housing developments as a public health intervention.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is currently insufficient evidence to establish the effectiveness of mixed income housing as a public health intervention.
Publication Date: 12/07/2009
The Problem:
Youth violence is an enormous public health problem in the United States, standing as the second leading cause of death for people between the ages of 10 and 24. CDC, National Center for Injury Prevention and Control. WISQRS. Juvenile court systems have often been criticized for inadequately deterring and poorly preventing recidivism among violent youthful offenders. Steiner B, Hemmens C, Bell V. Legislative Waiver Reconsidered: General Deterrent Effects of Statutory Exclusion Laws Enacted Post-1979. Justice Quarterly. 2006;23(1):34-59.
The Law:
All states have adopted laws that allow judicial waiver of jurisdiction by the juvenile court system, which sends young offenders to adult criminal systems. Some states use a discretionary approach, giving deference to the juvenile court judge. Other states employ an automatic approach: jurisdiction is waived for specific violent offenses or when the offender has prior violent arrests. For examples of juvenile waiver laws, see RCW 13.40.110 (Washington), Fla Stat § 985.556 (Florida), and MN Stats 260B.101 (Minnesota).
The Evidence:
In a systematic review, a Community Guide expert panel reviewed seven studies evaluating the impact of six laws allowing juvenile transfer. McGowan A, Hahn R, Liberman A, et al. Effects on violence of laws and policies facilitating the transfer of juveniles from the juvenile justice system to the adult justice system: a systematic review. Am J Prev Med 2007;32(4S):S7–S28. Across the studies, the reviewers observed an overall negative effect. Notably, there was a 34 percent median increase in recidivism among youths processed though adult systems compared to those retained in the juvenile courts. In addition, transfer of youths led to an increase in pretrial violence, victimization and violence in adult facilities, and elevated suicide rates among the incarcerated youths. According to the expert panel, there was not enough evidence to determine the true effect of waiver as a deterrent.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is sufficient evidence to conclude that processing youths through adult systems has a negative impact on public health.
Additional Resources: Heilbrun, et al. A National Survey of US Statutes on juvenile transfer: implications for policy and practice. Behavioral Sciences and the Law. 1998;15(2):125-149.
Origin: RNMCT, January 2010
Additional URL(s):
The Research Network on Mandated Community Treatment
Will the new Health Care Decisions Act in Virginia improve public health?
Origin: Richmond Times-Dispatch, Dec. 20, 2009
Additional URL(s):
Richmond Times-Dispatch, Dec. 20, 2009
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Public Health Law Research is a national program of the Robert Wood Johnson Foundation. It is housed at the Temple University Beasley School of Law.