Characteristic substance misuse profiles among youth entering an urban emergency department: neighborhood correlates and behavioral comorbidities

Background: Little is known about characteristic profiles of substance use – and their individual- and neighborhood-level correlates – among high-risk youth. Objectives: 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. Methods: 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. Results: 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. Conclusion: 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.