title: Substance use and risk of death in young offenders: a prospective data linkage study.
abstract: OBJECTIVE
  Young offenders are at increased risk of preventable death after release from custody, but risk factors for death in this population are poorly understood. Despite their poor health profiles, no studies have examined mortality outcomes in young people who have served community-based orders. The aims of this study were to describe the causes and identify risk factors for death in a cohort of young offenders in Victoria, Australia.
  
  
  METHODS
  We interviewed young people serving a custodial (n = 273) or community-based order (n = 242) in Victoria, Australia in 2002-2003. Measures included demographics and family history, offence history, experience of victimisation, mental illness, self-harm and substance use. Deaths up to 31 December 2011 were identified through a probabilistic linkage with the National Death Index.
  
  
  RESULTS
  The all-cause crude mortality rate was 4.2 (95% confidence interval 2.7-6.8) per 1000 person years and was not significantly different for those who had served custodial and community-based orders. Most deaths were due to drug overdose, traffic accidents or suicide. Adjusting for age, sex and order type, risk factors for death from the baseline interview included weekly use of opioids, sleeping pills or painkillers, polydrug use and injecting drug use.
  
  
  CONCLUSIONS
  Young people who have served community-based and custodial orders are at an increased risk of preventable death. Those engaging in risky substance use, particularly injecting drug use and use of multiple central nervous system depressants, are at greatest risk. There is an urgent need to develop and rigorously evaluate preventive interventions.
authors: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne, Australia; School of Medicine, University of Queensland, Brisbane, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors: Stuart A
authors: SA
authors: Kinner
authors: Louisa
authors: L
authors: Degenhardt
authors: Carolyn
authors: C
authors: Coffey
authors: Stephen
authors: S
authors: Hearps
authors: Matthew
authors: M
authors: Spittal
authors: Susan M
authors: SM
authors: Sawyer
authors: George C
authors: GC
authors: Patton
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D000293:Adolescent; D002423:Cause of Death; D057237:Criminals / Q000706:statistics & numerical data; D003625:Data Collection; D062787:Drug Overdose / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000401:mortality; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000401:mortality; D013405:Suicide / Q000706:statistics & numerical data; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: injecting drug use; mortality; substance abuse; suicide; youth offender