Substance use contributes to significant societal burdens, including high-cost health care use. However, these burdens may vary by type of substance and level of involvement. Using the 2009–13 National Surveys on Drug Use and Health, we examined all-cause hospitalizations and estimated costs across substance use profiles for alcohol, marijuana, and other illicit drugs. For each substance, we characterized differences between abstainers, nondiagnostic users (people who used the substance but did not meet diagnostic criteria for substance use disorder), and people with substance use disorders. In a multivariate analysis, we found that the odds of hospitalization were 16 percent lower for nondiagnostic marijuana users and 11 percent lower for nondiagnostic alcohol users, compared to abstainers. Neither alcohol- nor marijuana-specific substance use disorders were associated with hospitalization. In contrast, substance use disorders for other illicit drugs were strongly associated with hospitalization: People with those disorders had 2.2 times higher odds of hospitalization relative to abstainers. A more detailed understanding of health care use in different substance user groups could inform the ongoing expansion of substance use services in the United States.

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Despite the strong correlation between HIV and corrections, testing and prevention efforts have largely been ignored among community corrections populations. The current study is a secondary analysis to compare characteristics of individuals under community corrections supervision who completed rapid HIV testing with those who refused such testing (N = 2,382) in Baltimore, Maryland, and Providence, Rhode Island. Results indicate that the following variables were significantly associated with the receipt of rapid HIV testing: being female (p = .024), Black race (p = .004), homeless (p = .016), early age of crime onset (p = .001), more drug use during the past 90 days (p = .033), and previously tested for hepatitis C virus/hepatitis B virus (p = .024). Such findings make it especially important that individuals under community supervision be linked with services in the community to ensure that HIV testing and health care planning occur simultaneously.

Urban neighborhoods are frequently associated with high rates of crime, unemployment, poor educational systems, poor housing conditions, and health related problems. Theories of social disorganization, social isolation, and broken windows all explain how and why social problems develop and persist within urban settings. Drawing on these theories, this study examines how residents perceive local community problems in an East Baltimore neighborhood. Eight focus groups were conducted with participants who live and/or work in the area to identify common neighborhood issues. Problems commonly identified were: the presence of physical disorder, issues related to crime and law enforcement, lack of employment opportunities, and limited youth activities. Embedded under many of these themes was the recognition that the neighborhood lacks collective efficacy to fix community problems and maintain social control. Implications for improving neighborhood disadvantage will be discussed.

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