title: Understanding the service needs of assault-injured, drug-using youth presenting for care in an urban Emergency Department.
abstract: BACKGROUND
  Violence is a leading cause of injury among youth 15-24years and is frequently associated with drug use. To inform optimal violence interventions, it is critical to understand the baseline characteristics and intent to retaliate of drug-using, assault-injured (AI) youth in the Emergency Department (ED) setting, where care for violent injury commonly occurs.
  
  
  METHODS
  At an urban ED, AI youth ages 14-24 endorsing any past six-month substance use (n=350), and a proportionally-sampled substance-using comparison group (CG) presenting for non-assault-related care (n=250), were recruited and completed a baseline assessment (82% participation). Medical chart review was also conducted. Conditional logistic regression was performed to examine correlates associated with AI.
  
  
  RESULTS
  Over half (57%) of all youth met the criteria for drug and/or alcohol use disorder, with only 9% receiving prior treatment. Among the AI group, 1 in 4 intended to retaliate, of which 49% had firearm access. From bivariate analyses, AI youth had poorer mental health, greater substance use, and were more likely to report prior ED visits for assault or psychiatric evaluation. Based on multivariable modeling, AI youth had greater odds of being on probation/parole (AOR=2.26; CI=1.28, 3.90) and having PTSD (AOR=1.88; CI=1.01, 3.50) than the CG.
  
  
  CONCLUSIONS
  AI youth may have unmet needs for substance use and mental health treatment, including PTSD. These characteristics along with the risk of retaliation, increased ED service utilization, low utilization of other health care venues, and firearm access highlight the need for interventions that initiate at the time of ED visit.
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA; National Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, MI 48105, USA.
authors.forename: Kipling M
authors.initials: KM
authors.lastname: Bohnert
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA; University of Michigan Injury Center, Ann Arbor, MI 48106, USA; Michigan Youth Violence Prevention Center, Flint, MI 48109, USA.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Walton
authors.affiliation: Brown University, Department of Emergency Medicine, Providence, RI 02903, USA; Brown University, Injury Prevention Center, Providence, RI 02903, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Ranney
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Bonar
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA; National Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, MI 48105, USA; University of Michigan Injury Center, Ann Arbor, MI 48106, USA.
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; University of Michigan Injury Center, Ann Arbor, MI 48106, USA; Michigan Youth Violence Prevention Center, Flint, MI 48109, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Zimmerman
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Booth
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI 48106, USA; Hurley Medical Center, Flint, MI, USA; University of Michigan Injury Center, Ann Arbor, MI 48106, USA; Michigan Youth Violence Prevention Center, Flint, MI 48109, USA. Electronic address: stroh@umich.edu.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Cunningham
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D006301:Health Services Needs and Demand; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology; D008824:Michigan / Q000453:epidemiology; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Alcohol; Assault; Emergency Department; Injuries; Substance use; Youth