Urban youth with low substance use may still face substantial needs

BACKGROUND: Adolescent substance use and exposure to neighborhood violence frequently co-occur in U.S. urban settings, particularly among racially minoritized and low-income youth. Despite shared exposure to environmental risk, some adolescents report low to no substance use. Guided by the adverse community experiences and resilience framework, this study identified classes of neighborhood risk and substance use among urban adolescents and examined whether emotional, behavioral, community, and demographic factors differentiated profile membership. METHODS: Cross-sectional survey data were collected from 743 adolescents aged 13-21 residing in a large Northeastern U.S. city. Five dichotomous indicators (witnessed neighborhood violence, seen drugs sold in their neighborhood, and lifetime vaping, alcohol, and marijuana use) were analyzed using latent class analysis. Multinomial logistic regression examined associations between class membership and emotional, behavioral, community, and demographic factors. RESULTS: A three-class solution was retained: No Neighborhood Risk Exposure/Low or No Substance Use (34%), High Exposure/Low or No Use (40%), and High Exposure/Polysubstance Use (26%). Compared with the High Exposure/Low or No Use class, the No Neighborhood Risk Exposure/Low or No Use class reported higher neighborhood support and lower racial discrimination, missing school, and suicidal thoughts. The High Exposure/Polysubstance Use class differed from the High Exposure/Low or No Use class primarily by higher depressive symptoms. CONCLUSIONS: Low substance use should not be interpreted as low need among adolescents exposed to neighborhood risk. Adolescent health and well-being efforts should assess mental health distress, suicidal ideation, racial discrimination-related experiences, and school disengagement alongside substance use.