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. 2024 May 17;21(5):639.
doi: 10.3390/ijerph21050639.

Polysubstance Use among Maryland High School Students: Variations across County-Level School Districts

Lindsey Webb  1 , Kechna Cadet  2 , Rashelle Musci  1 , Shaheen Kurani  3 , Laura K Clary  1 , Danielle German  4 , Renee M Johnson  1
Affiliations

Polysubstance Use among Maryland High School Students: Variations across County-Level School Districts

Lindsey Webb et al. Int J Environ Res Public Health. .

Abstract

Background: Polysubstance use is a highly prevalent public health issue, particularly among adolescents, and decisions on prevention programming and policies are often made at the local level. While there is a growing literature examining patterns of polysubstance use among adolescents, little is known about differences in those patterns across geographic regions.

Methods: Using a large, representative sample of high school students from the state of Maryland (n = 41,091) from the 2018 Maryland Youth Risk Behavior Survey, we conducted a latent class analysis (LCA) of adolescent substance use along nine binary indicators, including past 30-day combustible tobacco, e-cigarette, alcohol, and cannabis use, as well as lifetime use of prescription opioids, cocaine, heroin, methamphetamine, and injection drug use. Measurement invariance across counties was examined using the Multiple Indicators and Multiple Causes (MIMIC) procedure.

Results: The results of the LCA show three classes of adolescent substance use for the total sample: (1) low substance use, (2) commonly used substances (i.e., e-cigarette, alcohol, and cannabis use), and (3) polysubstance use. The results from the MIMIC procedure demonstrated geographic differences in students' endorsement of specific indicators and their class membership.

Conclusions: These differences demonstrate the need for an examination of local trends in adolescent polysubstance use to inform multi-tiered prevention programming and policy.

Keywords: adolescence; county; polysubstance use; prevention; school districts.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Model-estimated latent classes based on 3-class solution. Note: NMPO = non-medical prescription opioid use.
Figure 2
Figure 2
Model-estimated latent class profiles based on 3-class multiple indicator multiple cause (MIMIC) LCA with county as source of DIF. Note: Interval bars are not included for heroin or methamphetamine as no significant DIF was identified for these indicators through the MIMIC modeling process. NMPO = non-medical prescription opioid use.
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