DOI: 10.3886/icpsr36558.v1
title: Substance Use Among Violently Injured Youth in an Urban Emergency Department: Services and Outcomes in Flint, Michigan, 2009-2013
title: Version 1

description: This project was an investigation into the natural course of service needs, use, and trajectories among high-risk youth and young adults with drug use who presented to an inner-city Emergency Department with multiple risk behaviors (with and without acute violent injury). Eligible participants included youth/young adults (ages 14-24) who sought care at the Hurley Medical Center (HMC) Emergency Department (ED) located in Flint, Michigan between December 19, 2009 and September 7, 2011. Consenting youth completed a self-administered computerized screening survey. All participants who self-reported past year drug use were recruited for the longitudinal study. For a comparison group, a randomly selected sample of drug using youth seeking ED care for other reasons (e.g. abdominal pain, motor vehicle crash) were selected for longitudinal study (equilibrated monthly proportionally for age/gender with the acute violent injury group). Participants in the violent injury and comparison group completed a baseline assessment during their ED visit. Dataset 1 (DS1) contains the Baseline Screener Data of both young adults and youth. This data file has 1,448 cases and 313 variables. Each case represents an individual seeking treatment in the emergency department. Dataset 2 (DS2) contains the Baseline Youth Data. This data file has 89 cases and 530 variables. Of these 89 cases, 51 of the youths (ages 14-17) presented to the Emergency Department with a violent injury. The remaining 38 respondents reported to the Emergency Department for non-violent injury and are part of the comparison group. Dataset 3 (DS3) contains the Baseline Young Adult Data. This file contains 511 cases and 482 variables. Of these 511 cases, 299 of the young adults (ages 18-24) presented to the Emergency Department with a violent injury. The remaining 212 respondents reported to the Emergency Department for non-violent injury and are part of the comparison group. The Baseline Screener Data includes demographics and information about public assistance, income, work, marital status, insurance, the injury visit, school/grades, retaliation attitudes, fights, violence, gang affiliation, weapons, partner violence, nicotine use, alcohol use, drug use, HIV risk-taking behaviors, needle use, sexual behavior, STD/HIV, past adolescent injuries, age on onset of drug use, and current conflict and aggression. The Baseline Youth and Young Adult Data include sexual behavior, threat of retaliation, brief symptom inventory/suicide risk, drug and alcohol refusal efficacy, drinking and driving (DUI), community involvement, peer influences, non-partner aggression, parental support, parent influence on drug and alcohol use, family conflict, mentors, fight self-efficacy, community violence, sexual risk behaviors, medical care, alcohol dependence/abuse, drug dependence/abuse, substance abuse service utilization, post traumatic stress disorder (PTSD), conduct disorder (youth) or antisocial personality disorder (young adult), legal system involvement, major depressive episodes, and mental health service utilization.
description: Substance Use Among Violently Injured Youth in an Urban Emergency Department was an investigation into the natural course of service needs, use, and trajectories among high-risk youth with drug use who present to an inner-city Emergency Department with multiple risk behaviors (with and without acute violent injury). By over-sampling of a violently injured group, the study was able to obtain a sufficient sample size that has been lacking in prior work limiting conclusions and intervention development. The specific aims of the study included: Specific Aim 1: To describe multiple risk behaviors of youth/young adults (ages 14-24) who report illicit drug use and who present to an urban Emergency Department for an acute violent injury (e.g., laceration, gun shot wound), compared to youth with drug use who seek non-violence related Emergency Department care (for unintentional injury and illness, e.g., motor vehicle crash, abdominal pain).; Specific Aim 2: To identify the trajectories of participants' interactions with health services during the two years following their Emergency Department visit for an acute violent injury or for non-violence related care, and the key characteristics (i.e., predisposing, enabling, and need factors) associated with types of service use and barriers to these services. Such services include substance abuse treatment, mental health services, and medical services including Emergency Department recidivism and HIV testing.; Specific Aim 3: To identify key sociodemographic and clinical characteristics, including HIV risk behaviors, for substance using youth who have poor outcomes in the two years after an Emergency Department visit for acute violent injury or non-acute violence related care.;
description: This study was designed to oversample youth (14-24 years) presenting to the ED for violent injury (i.e., assault related) and reporting past 6 month substance use. Patients completed screening and surveys during their ED visit. However, those with violent injuries too severe to participate in the ED were recruited if they stabilized in the hospital within 72 hours. Based on the age block (14-17, 18-20, 21-24) and sex (male/female) of enrolled youth presenting with violent injury, a proportionally selected comparison group was sampled of youth who presented for non-assault related complaints (e.g., abdominal pain, fever) and reported past 6 month substance use. Comparison youth were approached based on triage time, to mirror the proportion of participants in each age/sex group of violently injured participants. Patients were approached by research assistants to participate in a screening survey to determine eligibility. Patients presenting to the ED for an acute sexual assault, child abuse, or suicidal ideation or attempt were excluded. Upon written consent/assent from the patient (and parent/guardian if age was less than 18), participants self-administered a computerized screening survey(~25 minutes) and chose a $1.00 gift (i.e., cards and lotion). Participants completed the surveys in treatment spaces without others present, in order to ensure confidentiality. Screened participants in the violently injured and comparison group reporting past 6 month substance use on the ASSIST (i.e., marijuana, cocaine, prescription stimulant, opiates, or sedatives/sleeping pills, methamphetamine, inhalants, hallucinogens, street opiates; World Health Organization ASSIST Working Group, 2002) were enrolled in the longitudinal study and completed a baseline assessment (~90 minutes; $20 remuneration), and a urine drug screen ($5) as well as oral HIV testing ($5; not reported here). The baseline interview included self-administered and research assistant administered portions (e.g., Time Line Follow Back [TLFB] interview). Our IRB did not allow for collection of additional data from refusals without written informed consent.
description: The dataset contains no weight variables.
description: ICPSR data undergo a confidentiality review and are altered when necessary to limit the risk of disclosure. ICPSR also routinely creates ready-to-go data files along with setups in the major statistical software formats as well as standard codebooks to accompany the data. In addition to these procedures, ICPSR performed the following processing steps for this data collection: Created variable labels and/or value labels.; Standardized missing values.; Checked for undocumented or out-of-range codes..
description: Presence of Common Scales: Established scales used for this study include: Conflict Tactics Scale (CTS); Alcohol Smoking and Substance Involvement Screening Test (ASSIST); Mini International Neuropsychiatric Interview (MINI-adult); Mini International Neuropsychiatric Interview for Adolescents and Children (MINI-kid);
description: Response Rates: The baseline survey had a response rate of 85.4 percent.
description: Datasets: 
 
 DS0: Study-Level Files 
 DS1: Baseline Screener Data 
 DS2: Baseline Youth Data 
 DS3: Baseline Young Adult Data
description: computer-assisted self interview (CASI), face-to-face interview 
This data collection provides the baseline data collected between December 19, 2009 and September 7, 2011.
Followups were conducted with the cohort at 6, 12, 18, and 24 months. These data are not currently part of this collection.
The variable DEID should be used to link respondents between the screener and wave data.
ICPSR created all of the variable labels for each dataset.
description: High-risk youth (ages 14-17) and young adults (ages 18-24) with drug use who present to an inner-city emergency department with multiple risk behaviors. Smallest Geographic Unit: None
description: Emergency department patients aged 14-24 presenting for violent injury and a similarly aged comparison population of patients presenting for any medical reason were eligible for screening. During screening, participants were included on the basis of self-reported drug use in the previous year. Exclusions from study participation included: Patients who presented with acute sexual assault (CSC); Child abuse (CPS); Suicidal ideation or attempt; Altered mental status precluding consent; Diagnosis of schizophrenia; No parent/guardian available to give consent for minors; Abnormal vitals that did not stabilize during entire length of stay; Blood pressure 85/x; Heart Rate greater than 130; Oxygen Saturation less than 85 percent; If the patient was intubated or on a ventilator; Active participation in another study; If the patient was in police custody / currently incarcerated; already in the Flint Youth Injury study; An ineligible screen for Flint Youth Injury within the past 6 months; If the patient did not understand English; If the patient had been seen for a violent injury that happened more than 72 hours prior to presenting to the ED; Recruitment started on December 20, 2009 between the hours of 2 p.m. and 12 a.m. with additional weekend sampling between 5 a.m. to 7 a.m. Violently injured patients who were still in the ED at the time of shift start or who triaged up to shift end and were sent into a waiting room or put in a patient room were recruited. Potential comparison group participants with triage times one hour after the time of shift start and up to one hour before shift end were recruited.On January 14 recruitment hours changed to 4 p.m. to 2 a.m. seven days a week. On January 22 recruitment hours were changed to 3 p.m. through 1 a.m. Starting April 15 recruitment hours were 5 a.m. through 2 a.m. On April 27 recruitment times were between 5 a.m. and 1 a.m. except for Tuesdays and Wednesdays when shifting began at 7 a.m. On September 2, a third shift (11 p.m. - 7 a.m.) was added 5 days a week, which provided 24 hour a day coverage Thursday through Monday. Winter holidays were excluded. However, recruitment days included summer holidays.