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Level of evidence III Cite this article Bone Joint J 2021;103-B(4)711-717. Substance abuse, particularly among homeless youths, is a significant public health challenge in the United States. Detailed data about health care utilization resulting from this preventable behavior remain sparse. This study aimed to compare health care utilization rates related to substance abuse among homeless and nonhomeless youths. A secondary data analysis evaluated records of homeless and nonhomeless patients under age 25 with a primary diagnosis of subst