Importance of Community Context in Understanding Substance Use Among Adolescents With Allegations of Maltreatment

This study examined the association between community disadvantage and substance use among adolescents referred to child protective services (CPS) and the interaction role of race/ethnicity in the association between community disadvantage and adolescent substance use. Findings revealed that higher county-level alcohol/drug mortality rates were associated with a higher risk of substance use across non-Hispanic Black, non-Hispanic white, and Hispanic adolescents. An interaction test showed that the association between county-level alcohol/drug mortality rates and risk of substance use was particularly stronger for non-Hispanic Black adolescents compared to non-Hispanic white adolescents. However, county-level vacant housing rates and low median household income did not show a significant association with adolescent substance use across all racial/ethnic groups. Results suggest that practitioners should screen for community-level substance risk levels to prevent substance use among historically marginalized racial-ethnic adolescents involved in CPS.