The Effect of Neighborhood Context on the Relationship Between Substance Misuse and Weapons Aggression in Urban Adolescents Seeking ED Care

Abstract

Background: Frameworks for studying the ecology of human behavior suggest that multiple levels of the environment influence behavior and that these levels interact. Applied to studies of weapons aggression, this suggests proximal risk factor (e.g., substance use) effects may differ across neighborhoods. Objectives: To estimate how the association between weapons aggression and substance use varies as a function of several community-level variables. Methods: Individual-level measures (demographics, behavioral measures) were obtained from a survey of youth aged 14–24 years old seeking care at a Level-1 ED in Flint, Michigan. Community-level variables were obtained from public sources. Logistic generalized additive models were used to test whether community-level variables (crime rates, alcohol outlets, demographics) modify the link between individual-level substance use variables and the primary outcome measure: self-reported past 6-month weapon (firearm/knife) related aggression. Results: The effect of marijuana misuse on weapons aggression varied significantly as a function of five community-level variables: racial composition, vacant housing rates, female headed household rates, density of package alcohol outlets, and nearby drug crime rates. The effect of high-risk alcohol use did not depend on any of the eight community variables tested. Conclusions: The relationship between marijuana misuse and weapons aggression differed across neighborhoods with generally less association in more disadvantaged neighborhoods, while high-risk alcohol use showed a consistently high association with weapons aggression that did not vary across neighborhoods. The results aid in understanding the contributions of alcohol and marijuana use to the etiology of weapon-related aggression among urban youth, but further study in the general population is required.

Keywords :

• violence
• spatial
• marijuana
• alcohol

THE AUTHORS

Jason E. Goldstick, PhD, is currently an Assistant Professor in the school of Health Sciences at Oakland University. Prior to this, he was research faculty in Emergency Medicine at the University of Michigan. Dr. Goldstick is a statistician whose substantive research has focused on understanding complex dynamics in a variety of health-related applications including mental health, infectious disease, substance use, and violence. A prominent theme in his broadly ranging work is the use of contextual information (e.g., age or properties of the environment) to uncover how relationships between variables change under different circumstances.

Robert I. Lipton, PhD, is currently works at the CA department of health helping to run the office of health equity, specifically supervising the health research statistics unit. Previous to this he was an associate professor in the emergency medicine department at the University of Michigan where he studied the spatial epidemiology of violence. He has been working on spatial methods in public health for over fifteen years and is very interested in how place effects individual health and social processes that negatively and positively affect health. He is also a poet and musician. His next book of poetry will be coming out next year.

Patrick M. Carter, MD, is an Assistant Professor of Emergency Medicine within the University of Michigan School of Medicine and an Injury Researcher within the CDC-funded University of Michigan Injury Center. Dr. Carter's research focuses on the intersection of substance use and violence, specifically intentional firearm violence.

Sarah A. Stoddard, PhD, is an Assistant Professor in the Division Department of Systems Leadership and Effectiveness Science, University of Michigan School of Nursing. Dr. Stoddard is also an Assistant Professor in the Department of Health Behavior and Health Education, University of Michigan School of Public Health. Her research focuses on understanding the interaction between individual-level factors and social and environmental factors and their influence on psychosocial development and health trajectories of at-risk youth. She is also interested in the application of behavioral and ecological approaches to preventing substance use and aggression among youth.

Manya F. Newton, MD, is a Emergency Physician/ Researcher who is an Clinical Lecturer in Emergency Medicine at the University of Michigan. After completing her emergency medicine residency she pursued additional training in research methods through a Robert Wood Johnson Clinical Scholars fellowship, obtaining an advanced degree in health and health care research design. Her research interests include medically underserved populations, drug and alcohol use in the inner city population, and geospatial analysis. Dr. Newton has worked for the last four years in the University of Michigan Injury Center researching injury and violence in the inner city population.

Thomas M. Reischl, PhD, is an Associate Research Scientist in the Department of Health Behavior and Health Education at the University of Michigan School of Public Health. He received his PhD in Community Psychology at the University of Illinois at Urbana-Champaign. His current research interests focus on the development and the evaluation of community-based public health programs, violence prevention programs, and obesity prevention programs. He is interested in conducting process and outcome evaluation studies that are collaborative, responsive, and client-centered. His previous work has included evaluations of family support programs, self-help programs, and programs for persons with disabilities.

Maureen A. Walton, PhD, his research interests include developing the efficacy of interventions for alcohol, drugs, and violence in community health care settings, such as the emergency department (ED), primary care, and substance use treatment. Her research focuses on the interrelationship among multiple risk behaviors, particularly among understudied populations such as adolescents, women, and African-Americans. Dr. Walton and colleagues recently completed studies examining the effectiveness of brief interventions for alcohol and violence among adolescents presenting to urban ED's, marijuana prevention interventions among youth in primary care settings, and health services interventions among adults with substance use disorders presenting to the ED.

Marc A. Zimmerman, PhD, is a Professor of Health Behavior and Health Education, and Pyschology at the University of Michigan. He is also Editor of Youth & Society. His research focuses on adolescent health and resilience.

Rebecca M. Cunningham, MD, is the Director of the UM Injury Center a CDC ICRC, Associate Chair for Research and Professor in the Department of Emergency Medicine, University of Michigan Medical School, and Professor, Health Behavior & Health Education, University of Michigan School of Public Health. Dr. Cunningham has a distinguished career in researching intentional injury and substance use prevention, particularly of youth and young adult populations. Her focus on brief interventions in the emergency room has helped position the emergency department as a critical location for public health interventions, specifically for violence. She is currently leading two NIH-funded studies on substance abuse: one focusing on the intersection of youth violence and drug use, and one focusing on underage alcohol misuse and associated injury. Dr. Cunningham concurrently continues her work as a practicing Emergency Department physician at the University of Michigan Health System.