Little is known about longitudinal health risks and justice involvement among juvenile justice system (JJS) populations. This study used a sample of n = 388 males involved in the JJS to examined longitudinal associations of a latent health risk factor, comprised of depression, marijuana use, and sexually transmitted infections, with post-JJS placement. Results indicate the health risk factor was relatively stable over three time points of JJS entry and associated with present and future JJS placement. Youths who were Hispanic, older, or living with a family member struggling with alcohol use had higher health risk. These findings underscore the need for JJS services that address health risks among persistent juvenile offenders, with consideration of cultural and family dynamics.