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ABSTRACT
Background: Understanding geographic variation in youth drug use is important for both identifying etiologic factors and planning prevention interventions. However, little research has examined spatial clustering of drug use among youths by using rigorous statistical methods. Objectives: The purpose of this study was to examine spatial clustering of youth use of tobacco, alcohol, and marijuana. Methods: Responses on tobacco, alcohol, and marijuana use from 1,292 high school students ages 13–19 who provided complete residential addresses were drawn from the 2008 Boston Youth Survey Geospatial Dataset. Response options on past month use included “none,” “1–2,” “3–9,” and “10 or more.” The response rate for each substance was approximately 94%. Spatial clustering of youth drug use was assessed using the spatial Bernoulli model in the SatScan™ software package. Results: Approximately 12%, 36%, and 18% of youth reported any past-month use of tobacco, alcohol, and/or marijuana, respectively. Two clusters of elevated past tobacco use among Boston youths were generated, one of which was statistically significant. This cluster, located in the South Boston neighborhood, had a relative risk of 5.37 with a p-value of 0.00014. There was no significant localized spatial clustering in youth past alcohol or marijuana use in either the unadjusted or adjusted models. Conclusion: Significant spatial clustering in youth tobacco use was found. Finding a significant cluster in the South Boston neighborhood provides reason for further investigation into neighborhood characteristics that may shape adolescents' substance use behaviors. This type of research can be used to evaluate the underlying reasons behind spatial clustering of youth substance and to target local drug abuse prevention interventions and use.
Acknowledgements
The 2008 Boston Youth Survey (BYS) was conducted in collaboration with the Boston Public Health Commission (Barbara Ferrer, Director), Boston’s Office of Human Services (Larry Mayes, Chief), Boston Public Schools (Carol Johnson, Superintendent), and the Office of the Mayor, the Honorable Thomas M. Menino. The survey would not have been possible without the participation of the faculty, staff, administrators, and students of Boston Public Schools, as well as faculty, staff, and students of Harvard School of Public Health, and City of Boston employees who participated in survey administration. We thank Jeff Blossom for providing technical assistance with building this data set. We thank Daniel Hagen for reviewing an early draft of this manuscript, and we thank Thayane Moreira and William Goedel for assistance with formatting the references.
Funding
Dr. Dustin Duncan was supported by his New York University School of Medicine Start-Up Research Fund to work on this project. Dr. Martin Kulldorff was supported in part by a grant from the National Institutes of Health (grant # R01CA165057). The 2008 Boston Youth Survey was funded by a grant from the Centers for Disease Control and Prevention (grant U49CE00740) to the Harvard Youth Violence Prevention Center at Harvard School of Public Health (David Hemenway, PhD, Principal Investigator). A grant to Dustin Duncan from Robert Wood Johnson Foundation’s Active Living Research Program (grant # 67129) supported the development of the Boston Youth Survey Geospatial Dataset. This study was supported by the Robert Wood Johnson Foundation Health and Society Scholars Seed Grant Program (grant to Dustin Duncan), Harvard Center for Population and Development Studies, Harvard School of Public Health.