DESCRIPTION (provided by applicant): Racial and ethnic minority youth are disproportionately represented in the juvenile justice (JJ) system, just as they are overrepresented among those living in poverty, those growing up in disorganized neighborhood environments and those with sexually transmitted infections (STIs) and unwanted pregnancies. Multiple societal and structural factors are associated with poorer sexual health outcomes for these youth, including limited access to, and availability of, health care services and their socia (and sexual transmission) networks. JJ youth are likely to accrue further legal charges and be incarcerated into adulthood, thereby perpetuating racial and ethnic health disparities within the adult criminal justice system. Despite that racial and ethnic disparities exist in both health and legal systems, the relationship between juvenile justice involvement and health (including sexual) disparities is highly understudied. Constitutional mandates require access to medical testing and treatment in correctional settings, including free access to sexual health care services; however, confined juveniles only represent approximately twenty percent of arrested youth and the current trend in juvenile justice is away from confinement. Waiting until youth are confined to provide increased access to sexual health services misses a tremendous opportunity to improve sexual health outcomes and reduce disparities for a broader group of juveniles. The objective of this study is therefore to provide data that will inform public health and juvenile justice structural intervention development and policy geared toward increasing access to and uptake of sexual health prevention, treatment, care and support services for court- involved, non-incarcerated (CINI) youth. We seek to collect qualitative and quantitative data from juvenile court and department of health key informants that will provide novel documentation of the barriers to and facilitators of increasing access to and uptake of sexual health services for CINI juveniles. A combination of qualitative semistructured interviews and a large-scale survey of a diverse US sample of court and department of health settings (N=300 respondents) will provide data on system attitudes, perceptions, practices and policies that limit or enable access to sexual health services for CINI juveniles.

PUBLIC HEALTH RELEVANCE: Juvenile justice youth are at risk for poorer sexual health outcomes such as HIV, other sexually transmitted infections and unintended teenage pregnancies. Racial and ethnic disparities in sexual health outcomes and criminal justice involvement appear inextricably intertwined and yet little attention has been paid to how juvenile justice and public health systems could most successfully partner to reduce juvenile sexual health disparities. This study will provide data from a diverse US sample of court and department of health settings to understand system-level attitudes, perceptions, practices and policies that limit or enable access to sexual health services for court-involved, non-incarcerated (CINI) juveniles. Data will inform structural intervention development and policy geared toward increasing access to and uptake of sexual health prevention, treatment, care and support services for CINI youth.