Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
J Adolesc Health. 2019 Aug;65(2):210-215. doi: 10.1016/j.jadohealth.2019.03.026.
Although estimates of heroin and injection drug use (IDU) among U.S. adolescents have remained low and stable, national data may mask local variation in use. Adolescent use may be higher in urban areas, many of which have historically high rates of heroin use and IDU. We investigate trends in heroin use and IDU among 9th-12th grade students in major urban centers in the U.S.
We used local Youth Risk Behavior Survey data from all large, urban school districts (n = 9) with at least 5 years of weighted, publicly available data. We used time series mean estimation to estimate the prevalence of heroin use and IDU among high school students from 1999 to 2017 and used logistic regression to test for linear and quadratic trends.
We observed statistically significant linear increases in (1) lifetime heroin use in New York (β = .43, 1%-3.9%), Chicago (β = .15, 3.1%-4.6%), and Milwaukee (β = .35, 2.8%-7.4%); and (2) lifetime IDU in New York (β = .34, .8%-2.7%), Orange County (β = .17, 2.2%-3.5%), and Miami-Dade County (β = .16, 2.7%-3.9%). Only San Bernardino experienced significant decreases in heroin use (β = -.34, 4.6%-1.6%) and IDU (β = -.20, 2.5%-1.9%) over the time period.
In contrast to national trends, the prevalence of heroin use is increasing among adolescents in certain urban centers in the U.S. Our results illustrate that national averages mask local variation in adolescent heroin use. Further research with locally representative samples is needed to inform public health policy and practice, especially in cities where heroin problems have been historically endemic and continue to rise.
尽管美国青少年的海洛因和注射吸毒（IDU）估计仍保持较低且稳定，但全国数据可能掩盖了使用方面的局部差异。在城市地区，青少年的使用可能更高，其中许多地区历来有较高的海洛因使用和 IDU 率。我们调查了美国主要城市中心 9 至 12 年级学生中海洛因使用和 IDU 的趋势。
我们使用了来自所有大城市学区的本地青年风险行为调查数据（n=9），这些学区的加权、公开可用数据至少有 5 年。我们使用时间序列均值估计来估计 1999 年至 2017 年高中生中海洛因使用和 IDU 的流行率，并使用逻辑回归来测试线性和二次趋势。
我们观察到以下具有统计学意义的线性增加：（1）纽约（β=0.43，1%-3.9%）、芝加哥（β=0.15，3.1%-4.6%）和密尔沃基（β=0.35，2.8%-7.4%）的终身海洛因使用；以及（2）纽约（β=0.34，0.8%-2.7%）、橙县（β=0.17，2.2%-3.5%）和迈阿密-戴德县（β=0.16，2.7%-3.9%）的终身 IDU。在这段时间内，只有圣贝纳迪诺经历了海洛因使用（β=-0.34，4.6%-1.6%）和 IDU（β=-0.20，2.5%-1.9%）的显著下降。
与全国趋势相反，美国某些城市中心青少年海洛因使用的流行率正在上升。我们的结果表明，全国平均水平掩盖了青少年海洛因使用的局部差异。需要进行具有本地代表性样本的进一步研究，以为公共卫生政策和实践提供信息，特别是在历史上一直存在海洛因问题且仍在上升的城市。
