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Scared Straight and other programs involve organized visits to prison facilities by juvenile delinquents or at-risk kids to deter them from delinquency. Despite several research studies and reviews questioning their effectiveness, they remain in use and have now been tried in at least six nations. The authors report here on the results of a systematic review of randomized experimental tests of this program. Studies that tested any program involving the organized visits of delinquents or at-risk children to penal institutions were included. Each study had to have a no-treatment control condition with at least one outcome measure of “postvisit” criminal behavior. Using extensive search methods, the authors located nine randomized trials meeting eligibility criteria. After describing the studies and appraising their methodological quality, the authors present the narrative findings from each evaluation. A meta-analysis of prevalence rates indicates that the intervention on average is more harmful to juveniles than doing nothing. The authors conclude that governments should institute rigorous programs of research to ensure that well-intentioned treatments do not cause harm to the citizens they pledge to protect.

We consider methods for assessing agreement or disagreement between the results of a meta-analysis of small studies addressing a clinical question and the result of a large clinical trial (LCT) addressing the same clinical question. We recommend basing conclusions about agreement upon the difference between the two results (relative risk, log-odds ratio or similar summary statistic), in the light of the estimated standard error of that difference. To estimate the standard error of the meta-analytic result we recommend a random effects analysis, and where a between-studies variance component is found, that component of variance should be used twice: once in the estimated standard error for the meta-analytic result and again in the standard error of the LCT result (augmenting the internal standard error of that statistic). Such broadening of the standard error reduces the appearance of disagreement. We also offer a critique of a different published approach, which is based on consistency of findings of statistical significance, a matter of how the two results regard zero, which is a poor measure of how closely they agree with each other.

The aim of this systematic review was to assess the effects of programs comprising organized visits to prisons by juvenile delinquents (officially adjudicated or convicted by a juvenile court) or predelinquents (children in trouble but not officially adjudicated as delinquents), aimed at deterring them from criminal activity. We only considered studies that randomly or quasi‐randomly (i.e. alternation) assigned participants to conditions. Each study had to have a no‐treatment control condition with at least one outcome measure of “post‐visit” criminal behavior. Nine trials were eligible. The analyses show the intervention to be more harmful than doing nothing. The program effect, whether assuming a fixed or random effects model, was nearly identical and negative in direction, regardless of the meta‐analytic strategy. We conclude that programs like ‘Scared Straight’ are likely to have a harmful effect and increase delinquency relative to doing nothing at all to the same youths. Given these results, agencies we cannot recommend this program as a crime prevention strategy. Agencies that permit such programs, however, must rigorously evaluate them not only to ensure that they are doing what they purport to do (prevent crime) ‐ but at the very least they do not cause more harm than good to the very citizens they pledge to protect. Consumer Synopsis Programs like ‘Scared Straight’ involve organized visits to prison facilities by juvenile delinquents or children at risk for becoming delinquent. The programs are designed to deter participants from future offending by providing first‐hand observations of prison life and interaction with adult inmates. Results of this review indicate that not only does it fail to deter crime but it actually leads to more offending behavior. Government officials permitting this program need to adopt rigorous evaluation to ensure that they are not causing more harm to the very citizens they pledge to protect. Executive Summary/Abstract BACKGROUND‘Scared Straight’ and other programs involve organized visits to prison by juvenile delinquents or children at risk for criminal behavior. Programs are designed to deter participants from future offending through first‐hand observation of prison life and interaction with adult inmates. OBJECTIVESTo assess the effects of programs comprising organized visits to prisons by juvenile delinquents (officially adjudicated or convicted by a juvenile court) or pre‐delinquents (children in trouble but not officially adjudicated as delinquents), aimed at deterring them from criminal activity. SEARCH STRATEGYSearches by the first author in identifying randomized field trials 1945–1993 relevant to criminology was augmented by structured searches of 19 electronic data bases, including the Campbell SPECTR database of trials and the Cochrane CCTR. Experts in the field were consulted and relevant citations were followed up. SELECTION CRITERIAStudies that tested the effects of any program involving the organized visits of juvenile delinquents or children at‐risk for de...

Tissue hypoxia as a result of a wide variety of clinical situations had frequently been implicated as a cause of systemic acidosis due to the accumulation of lactic acid. Four patients suffering from smoke inhalation had lactic acidosis in association with carboxyhemoglobinemia. There was no evidence of decreased tissue perfusion, hypotension, arterial hypoxemia, or anemia. The following were tested in all patients: arterial pH (7.25 to 7.40), Pco-2 (19 to 27 mm Hg), Po (63 to 116 mm Hg), HCO-2- (11 to 19 meq/litre), carboxyhemoglobin (13% to 37%), and lactic acid (5.1 to 9.3 meq/litre). After therapy with oxygen and intravenous corticosteroids, there was prompt return of lactic acid levels, carboxyhemoglobin values, and arterial pH to normal. It is concluded that the cause of lactic acidosis in the presence of carboxyhemoglobinemia during smoke inhalation is tissue hypoxia. This tissue hypoxia is due to the reduction of the oxygen-carrying capacity of the blood and the concomitant shift of the oxyhemoglobin dissociation curve to the left, both known to result from carboxyhemoglobinemia.