Abstract Temperature extremes represent an emerging, but understudied environmental determinant of adolescent behavioral health, with little known about how these risks vary geographically. This study examined patterns of substance use–related emergency department visits among individuals age 24 and under in North Carolina using statewide data. Statewide hospital data were linked with high-resolution temperature records from NOAA’s nClimGrid-Daily dataset to identify heatwave and coldwave days, defined using local 95th- and 5th-percentile thresholds of daily mean temperature. We applied Bernoulli spatial scan statistics to detect clusters of elevated visit risk during extreme temperature events and multivariable logistic regression to assess the association between cluster membership and demographic, clinical, and environmental factors. Significant clusters were identified during both heatwaves and coldwaves. Heatwave clusters occurred mainly in the eastern coastal plain, while coldwave clusters were concentrated in the western mountains. Visits within heatwave clusters were more likely to involve government or military insurance, prescription drug use, and cannabis or stimulant-related diagnoses. Coldwave clusters were linked to stimulant and polysubstance use and were more common among female and adolescent patients. These results suggest that temperature extremes and underlying populations interact to shape behavioral health risks.
Blackburn et al. (Sun,) studied this question.