Characteristic substance misuse profiles among youth entering an urban emergency department: neighborhood correlates and behavioral comorbidities.
Little is known about characteristic profiles of substance use - and their individual- and neighborhood-level correlates - among high-risk youth.



To identify characteristic substance misuse profiles among youth entering an urban emergency department (ED) and explore how those profiles relate to individual- and community-level factors.



Individual-level measures came from screening surveys administered to youth aged 14-24 at an ED in Flint, Michigan (n = 878); alcohol outlet and crime data came from public sources. Binary misuse indicators were generated by using previously established cut-points on scores of alcohol and drug use severity. Latent class analysis (LCA) identified classes of substance use; univariate tests and multinomial models identified correlates of class membership.



Excluding non-misusers (51.5%), LCA identified three classes: marijuana-only (27.9%), alcohol/marijuana (16.1%), and multiple substances (polysubstance) (4.6%). Moving from non-misusers to polysubstance misusers, there was an increasing trend in rates of: unprotected sex, motor vehicle crash, serious violence, weapon aggression, and victimization (all p < .001). Controlling for individual-level variables, polysubstance misusers lived near more on-premises alcohol outlets than non-misusers (RRR = 1.42, p = .01) and marijuana-only misusers (RRR = 1.31, p = .03). Alcohol/marijuana misusers were more likely to live near high violent crime density areas than non-misusers (RRR = 1.83, p = .01), and were also more likely than marijuana-only misusers to live in areas of high drug crime density (RRR = 1.98, p = .03). No other relationships were significant.



Substance-misusing youth seeking ED care have higher risk for other problem behaviors and neighborhood-level features display potential for distinguishing between use classes. Additional research to elucidate at-risk sub-populations/locales has potential to improve interventions for substance misuse by incorporating geographic information.
a Department of Emergency Medicine , University of Michigan , Ann Arbor , MI , USA.|b Injury Research Center , University of Michigan , Ann Arbor , MI , USA.
Jason E
JE
Goldstick
b Injury Research Center , University of Michigan , Ann Arbor , MI , USA.|c University of Michigan Youth Violence Prevention Center , Ann Arbor , MI , USA.|d School of Nursing , University of Michigan , Ann Arbor , MI , USA.
Sarah A
SA
Stoddard
a Department of Emergency Medicine , University of Michigan , Ann Arbor , MI , USA.|b Injury Research Center , University of Michigan , Ann Arbor , MI , USA.|c University of Michigan Youth Violence Prevention Center , Ann Arbor , MI , USA.|e Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA.
Patrick M
PM
Carter
b Injury Research Center , University of Michigan , Ann Arbor , MI , USA.|c University of Michigan Youth Violence Prevention Center , Ann Arbor , MI , USA.|e Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA.
Marc A
MA
Zimmerman
b Injury Research Center , University of Michigan , Ann Arbor , MI , USA.|c University of Michigan Youth Violence Prevention Center , Ann Arbor , MI , USA.|e Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA.
Maureen A
MA
Walton
a Department of Emergency Medicine , University of Michigan , Ann Arbor , MI , USA.|b Injury Research Center , University of Michigan , Ann Arbor , MI , USA.|c University of Michigan Youth Violence Prevention Center , Ann Arbor , MI , USA.
Rebecca M
RM
Cunningham
D000293:Adolescent; D000374:Aggression; D000428:Alcohol Drinking / Q000453:epidemiology; D000434:Alcoholic Beverages / Q000600:supply & distribution; D003132:Commerce / Q000706:statistics & numerical data; D015897:Comorbidity; D019548:Crime Victims / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014505:Urban Population / Q000706:statistics & numerical data*; D014754:Violence / Q000706:statistics & numerical data; D055815:Young Adult
Polysubstance use; neighborhood; problem behaviors; violence