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Little is still known how the unprecedented COVID\u201019 pandemic affected health outcomes like substance use and how this varied across key demographics and community characteristics. This analysis aims to examine how individual and community contexts interact to predict the risk of substance use outcomes among young people (ages 24 and younger) with additional consideration of the COVID\u201019 pandemic. We employ generalized logistic mixed models to examine the main and interactive effects of individual and community context in predicting substance use\u2010related emergency department (ED) visits. We assess effect modification of this association by key individual variables (age, race, sex, income\u2014using insurance as proxy), community variables (community economic deprivation\u2014derived from principal component analysis), and the COVID\u201019 pandemic. Results show low\u2010income youth are associated with higher risks of substance use compared to their higher income peers (OR\n                    <jats:sub>Uninsured<\/jats:sub>\n                    :1.82, CI:1.81\u20131.83). Community context moderated risk, particularly for children in low\u2010income communities (OR\n                    <jats:sub>Alcohol<\/jats:sub>\n                    :3.39, CI:1.94\u20135.93). Findings further demonstrate a higher risk of substance use ED visits during the pandemic among low\u2010income youth (OR\n                    <jats:sub>PublicInsurance<\/jats:sub>\n                    :1.09, CI:1.07\u20131.10) and youth in low\u2010income communities (OR:1.03, CI:1.01\u20131.05), those 18 and younger (OR\n                    <jats:sub>Adolescents<\/jats:sub>\n                    :1.25, CI:1.23\u20131.27), and Black (OR:1.32, CI:1.30\u20131.33), Indigenous (OR:1.17, CI:1.12\u20131.22), and Hispanic youth (OR:1.13, CI:1.11\u20131.15). Results emphasize the ongoing need for substance use resources targeted to young people in low\u2010income and median\u2010income communities, particularly younger youth and youth of color, who are associated with marked increases in substance use in recent years.\n                  <\/jats:p>","DOI":"10.1002\/jcop.70142","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T04:27:41Z","timestamp":1788841661000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Substance Use Emergency Department Visits Among Young People: Exploring Individual and Contextual Risk Factors"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0852-3733","authenticated-orcid":false,"given":"Sophia C.","family":"Ryan","sequence":"first","affiliation":[{"name":"Department of Geography and Planning Appalachian State University Boone North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4611-1745","authenticated-orcid":false,"given":"Jennifer D.","family":"Runkle","sequence":"additional","affiliation":[{"name":"North Carolina Institute for Climate Studies NC State University Asheville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5879-9615","authenticated-orcid":false,"given":"Martie P.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Public Health Appalachian State University Boone North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5487-338X","authenticated-orcid":false,"given":"David","family":"Karp","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine Thomas Jefferson University Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0315-4860","authenticated-orcid":false,"given":"Margaret M.","family":"Sugg","sequence":"additional","affiliation":[{"name":"Department of Geography and Planning Appalachian State University Boone North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2022.03.015"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-021-01194-2"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","unstructured":"Arora P. 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