Social determinants of health are key factors contributing to health disparities in the United States. African-Americans are disproportionately at risk for exposure to societal stressors, including neighborhood violence (Katz, Esparza, Carter, Grant, & Meyerson, 2012). One societal stressor, community trauma, has been directly or indirectly associated with poor health outcomes, including intimate partner violence (Caetano, Ramisetty-Mikler, & Harris, 2010; Raiford, Seth, Braxton, & DiClemente, 2013), substance use (Seth, Murray, Braxton, & DiClemente, 2013), sexual risk behavior (Voisin, Jenkins, & Takahashi, 2011; Wilson, Woods, Emerson, & Donenberg, 2012) and poor mental health outcomes (Katz et al., 2012; Slopen, Fitzmaurice, Williams, & Gilman, 2012; Zona & Milan, 2011). Community trauma consists of acts of aggression (e.g. muggings, robberies, rape, gang or gun-related incidents) outside the home among people who may or may not know each other (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002).

Previous research indicates that while boys experience more neighborhood stressors, girls may manifest greater adverse outcomes (Zona & Milan, 2011). These adverse outcomes may be further exacerbated among vulnerable female adolescents, such as those in the juvenile justice system. Compared to non-detained girls, detained girls are at higher risk for several adverse health outcomes, including substance use, poor mental health and sexual risk behavior (Chesney-Lind & Sheldon, 1998; Robertson et al., 2011; Tolou-Shams, Stewart, Fasciano, & Brown, 2010). Therefore, the present study aims to better understand the impact of community trauma on these multiple adverse outcomes among detained African-American female adolescents at baseline, 3-month and 6-month follow-up. To our knowledge, this is one of the first studies to longitudinally examine the impact of community trauma on adverse health outcomes among this population.

From March 2011 to February 2012, female adolescents from a short-term juvenile detention facility were screened for enrollment in a culturally sensitive HIV prevention program (DiClemente et al., 2014). African-American females aged 13–17 years who reported lifetime vaginal intercourse were eligible. Adolescents who were married, currently pregnant, wards of the State of Georgia or scheduled to be placed in a restricted location upon release were excluded. Of the 202 eligible adolescents, 188 (93.1%) completed baseline assessments; of those, 172 completed 3-month assessments (91.5%) and 171 (91%) completed 6-month assessments. Participants provided written informed assent, and parents provided verbal consent. Participants were not compensated while detained but were given up to $150 for completion of all intervention sessions and assessments over the 6-month follow-up period, subsequent to release from detention. The Institutional Review Board approved all study protocols prior to implementation.

Participant characteristics experiencing community trauma and study outcomes are in Table 1. Participants’ mean age was 15.3 years (SD = 1.1) at baseline, and the average number of days detained was 3.8 (SD = 4.9). A majority (71.3%) reported having lived in a household that received public financial assistance, and 93% had completed ninth or tenth grade.

Logistic regression analyses indicated that those who reported high levels of community trauma were more likely to report unprotected sex, sex partner(s) with corrections or juvenile justice history, sexual sensation seeking, marijuana use, deviant peers and PTSD symptoms at baseline. GEE analyses indicated that high levels of community trauma at baseline significantly predicted unprotected sex and marijuana use over 3-month follow-up. Additionally, high levels of community trauma at baseline significantly predicted sexual sensation seeking, deviant peers and PTSD symptoms over the 3-month and 6-month follow-up (Table 2).

The current findings highlight the impact of a community-level social determinant of health on multiple health outcomes (Caetano et al., 2010; Katz et al., 2012; Raiford et al., 2013; Seth et al., 2013; Slopen et al., 2012; Voisin et al., 2011; Wilson et al., 2012; Zona & Milan, 2011). High exposure to community trauma was associated with sexual risk, marijuana use and PTSD symptoms among African-American female adolescents experiencing short-term detention. These findings were consistent with previous findings identifying community trauma as directly or indirectly associated with intimate partner violence, substance use, sexual risk behavior and poor mental health outcomes (Caetano et al., 2010; Katz et al., 2012; Raiford et al., 2013; Seth et al., 2013; Slopen et al., 2012; Voisin et al., 2011; Wilson et al., 2012; Zona & Milan, 2011). Adolescents living in a high-risk environment may engage in health risk behaviors, such as substance use and sexual risk behavior, to cope with and alleviate stress from immediate stressors or threats (Latkin, Curry, Hua, & Davey, 2007; Seth et al., 2013).

Furthermore, in the present study, by the 6-month follow-up, the individual-level risk behaviors were no longer associated with community trauma. However, affiliation with deviant peers and PTSD symptoms remained significant. For girls released into the same community, they continue to be exposed to deviant peer groups and traumatic events. Supporting communities that experience high rates of community violence and incarceration may be valuable in addressing community-level factors that can impact the health outcomes of adolescent girls involved in the juvenile justice system.

There are study limitations. The definition of community trauma was limited. Data are self-reported and subject to social desirability bias. The sample was homogenous; thus, the findings may not be generalizable to all detained adolescents or detained male adolescents. Finally, the sample size was relatively small (N = 188), which may limit precision of effect estimates. Further research with larger samples and diverse populations is important.

These findings suggest that there is a need to proactively address community factors and adverse health outcomes among female adolescents to prevent sustainment of risk behaviors into adulthood (Abram, Stokes, Welty, Aaby, & Teplin, 2017; Barnet et al., 2017). Integration of social and health services may help address co-occurring issues, such as mental health, substance use, sexual risk and violence, particularly in high-risk environments and among vulnerable populations. Examination of contextual factors that may affect community trauma, such as low socioeconomic status, unstable housing, economic and social deprivation, poor educational opportunities, residential segregation and inadequate health care, is important (Adimora & Schoenbach, 2002; Seth et al., 2013). Structural and community-level interventions and policy-level change may help improve access to resources to strengthen social and familial networks, improve educational systems, reduce neighborhood violence and criminal behavior and improve overall health and standard of living in communities.