It refers to criminal organisations (mainly gangs moving drugs, weapons etc) which operate across county lines (ie. across multiple counties). This name is given to make clear the difference between a local gang which operates in a single city and one which spans across a larger geographic area, even if their activities are similar.
It’s not really a youth culture thing, the name has been popularised by the press and I can’t imagine hearing anyone under the age of 30 saying it seriously.
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