Substance Use Emergency Department Visits Among Young People: Exploring Individual and Contextual Risk Factors

Evidence demonstrates that individual and contextual factors are critical predictors of poor health outcomes at key life stages, including youth and young adulthood. Little is still known how the unprecedented COVID-19 pandemic affected health outcomes like substance use and how this varied across key demographics and community characteristics. This analysis aims to examine how individual and community contexts interact to predict the risk of substance use outcomes among young people (ages 24 and younger) with additional consideration of the COVID-19 pandemic. We employ generalized logistic mixed models to examine the main and interactive effects of individual and community context in predicting substance use-related emergency department (ED) visits. We assess effect modification of this association by key individual variables (age, race, sex, income-using insurance as proxy), community variables (community economic deprivation-derived from principal component analysis), and the COVID-19 pandemic. Results show low-income youth are associated with higher risks of substance use compared to their higher income peers (OR_Uninsured:1.82, CI:1.81-1.83). Community context moderated risk, particularly for children in low-income communities (OR_Alcohol:3.39, CI:1.94-5.93). Findings further demonstrate a higher risk of substance use ED visits during the pandemic among low-income youth (OR_{PublicInsurance}:1.09, CI:1.07-1.10) and youth in low-income communities (OR:1.03, CI:1.01-1.05), those 18 and younger (OR_Adolescents:1.25, CI:1.23-1.27), and Black (OR:1.32, CI:1.30-1.33), Indigenous (OR:1.17, CI:1.12-1.22), and Hispanic youth (OR:1.13, CI:1.11-1.15). Results emphasize the ongoing need for substance use resources targeted to young people in low-income and median-income communities, particularly younger youth and youth of color, who are associated with marked increases in substance use in recent years.