Online Program

A Patient-Centered Model of Substance Use Prevention for Youth with Chronic Medical Conditions

Sunday, November 1, 2015

Elissa Weitzman, ScD, MSc, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
Parissa K Salimian, BA, Boston Children's Hospital, Boston, MA
Lily Rabinow, MS, Boston Children's Hospital, Boston, MA
Sharon Levy, MD, MPH, Boston Children's Hospital, Boston, MA
Lauren Wisk, PhD, Boston Children's Hospital and Harvard Medical School, Boston, MA
Background.  20% of US youth have a chronic medical condition (CMC). Emerging research indicates these youth use alcohol and marijuana. While substance use may confer unique health risks for these youth, models of adolescent risk-taking and substance use prevention imperfectly apply to them.

Objective.  To elucidate domains of a substance use prevention model applicable to youth with a CMC grounded in patient-centered harms, concerns about risk taking and health protection.  

Methods.  Narrative interviews were conducted with a consented purposively selected sample of youth ages 16-19 years in subspecialty care for a CMC. Interviews were in English, audio-recorded, transcribed and thematically analyzed under IRB approval.

Results.  Of 20 youth, 11 had rheumatic diseases, including 2 with IBD-associated arthritis; 4 had type 1 diabetes; 4 had ADHD; 1 had chronic persistent asthma. 13 were female. Across respondents, factors reported to inhibit substance use were concern for: i) negative interactions between alcohol and medications; ii) poor medication adherence related to substance use; and, iii) exacerbation of disease activity from substance use. Social pressure to use was diminished among youth who felt that their condition had matured them. Information about negative alcohol-medication interactions reportedly inhibited regular or heavy drinking, while experience of symptom amelioration from marijuana use reportedly motivated smoking.  

Discussion and Implications. Substance use prevention models need tailoring to address special concerns and strengths of medically vulnerable youth. Potential for substance use to undermine therapies and exacerbate disease are salient patient-centered harms that may ground prevention messages, as may guidance that reinforces this group’s sense of maturity and autonomy. Research is needed to build and test effective, tailored prevention models for this group.

Learning Areas:

Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe salient patient-centered harms related to substance use for adolescents with chronic medical conditions that may motivate prevention programs. Identify persuasive substance use prevention messages and clinician guidance for use with chronically ill adolescents. Explain key differences between standard adolescent substance use prevention models for healthy and chronically ill youth including differences in how youth conceptualize risk over time, salience of consequences, values for self protection.

Keyword(s): Chronic Disease Management and Care, Preventive Medicine

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an Instructor in the Division of Adolescent/Young Adult Medicine at Boston Children's Hospital and the Department of Pediatrics at Harvard Medical School. My research interests include understanding access to specific healthcare services among vulnerable populations, the correlation of healthcare utilization and outcomes within families, and time trends in disparities in access to care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.