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The Ecology of Adolescent Substance Abuse Service Utilization

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American Journal of Community Psychology

Abstract

This paper presents an ecological-community model toward the explanation of variation in patterns of substance abuse (SA) service utilization among adolescents who are enrolled in Tennesssee’s Medicaid program (TennCare). Guided by a theoretical framework that draws from the social ecology work of Bronfenbrenner and health services utilization models promoted by Aday and Andersen, we apply a social indicators approach toward explaining the impact of community ecology on identification of SA and treatment engagement. Both county-level rates and individual-level treatment utilization are examined and hierarchical linear modeling is incorporated to examine the individual-in-community phenomenon. This study is an expansion of previous service utilization research and suggests that explanations of youth’s service utilization must necessarily include not only individual, familial, and service system characteristics, but community factors, as well.

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Notes

  1. Fixed effects specifications were tested, but the random effects specification was superior. (Results available from authors.)

  2. The model was estimated alternatively with a fixed- or random-intercept. The random-intercept model fit better.

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Acknowledgements

Preparation of this article was supported by Center for Substance Abuse Treatment in the Substance Abuse and Mental Health Services Administration (1KD1 TI112328) and the National Institute on Drug Abuse (RO1 DA12982, R21 DA017682).

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Correspondence to Diana L. Jones.

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Jones, D.L., Heflinger, C.A. & Saunders, R.C. The Ecology of Adolescent Substance Abuse Service Utilization. Am J Community Psychol 40, 345–358 (2007). https://doi.org/10.1007/s10464-007-9138-8

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