Delinquent children are much more likely than their nondelinquent peers to die violently later in life, a study finds. And girls who ended up in juvenile detention were especially vulnerable, dying at nearly five times the rate of the general population.

"This was astonishing," says Linda Teplin, a professor of psychiatry and behavioral sciences at Northwestern University's medical school and the lead author of the study.

The researchers interviewed 1,829 people, ages 10 to 18, who were detained at the Cook County Juvenile Temporary Detention Center in Chicago between 1995 and 1998. The young people were arrested for a variety of reasons, but they weren't necessarily convicted of a crime.

The researchers continued to follow up with them over the years. By 2011, 111 of them had died, and more than 90 percent of them were killed with guns. The findings were published Monday in the journal Pediatrics.

"I would have anticipated the death rate to be somewhat higher [than that of the general population], but not the figures that you see," Teplin tells Shots.

Young women in the study died at much higher rates than their peers in part because the rate of violent death among women in the general population is relatively low, the researchers say.

Delinquent youths from every demographic group died at significantly higher rates than their peers from the Chicago area. And their death rates were nearly twice those of combat troops in wartime Iraq and Afghanistan, the researchers say.

But minorities were at particular risk. African-American men in this study had the highest mortality rates, and they were 4 1/2 as likely as the white men to die of homicide. Latino men were five times as likely to die as the general population, and Latino women were nine times as likely to die early.

Lack of access to mental health care and other resources may be an important factor. The vast majority of these young delinquents come from poor communities, Teplin says. "Detention centers are where poor kids go. Wealthier kids have other options."

The researchers never encountered a juvenile from the affluent suburbs of Chicago, she says. Even though young people from wealthy families may abuse and sell drugs, they generally have better support systems and access to treatments.

The kids who end up in juvenile detention often have mental health or substance abuse problems, Teplin notes, but they don't get the care they need.

Many of the young people who died in this study dealt drugs and were involved with gangs, the study found. And many had problems with alcohol.

"So often these kids have an illness like depression. So they self-medicate with drugs," Teplin says. "And then they end up arrested and detained and caught in a downward spiral."

The Affordable Care Act has made it a little easier for these young people to get care, Teplin says. The health care law established a Prevention and Public Health Fund to support public health initiatives.

The law allows families to get low-cost coverage through state or federal exchanges. And it requires insurance companies to guarantee the same amount of coverage for mental health as they do for other medical treatments.

Community intervention programs have also been shown to help catch at-risk youths before they end up in the juvenile detention system, or after they get out. "There are so many things that can be done. There are effective strategies for preventing violence and crime," says J. David Hawkins, a professor of social work at the University of Washington and co-developer of the program, which works with community leaders to implement a series of interventions designed to empower local youth.

"The first thing that needs to happen is the public needs to know that effective interventions exist," Hawkins tells Shots. And the public needs to put pressure on social institutions to start funding and implementing these programs, he says.

Communities That Care has worked in cities and towns around the country to conduct surveys, identify the big issues that affect young people in each area and roll out interventions tailored to fit each community's needs. The process takes a lot of time and money, Hawkins says. As do most other effective public health programs.

"Crime is expensive," he says. "We have to think about how we can invest more of the resources focused on young people on prevention and successful development instead of exclusively on remediation."

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