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334114
Alcohol, Tobacco, and Marijuana Use Risks among a National Sample of Youth with Chronic Medical Conditions


Sunday, November 1, 2015

Lauren Wisk, PhD, Division of Adolescent/Young Adult Medicine and Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA
Elissa Weitzman, ScD, MSc, Department of Pediatrics, Harvard Medical School, Boston, MA
Adolescence and emergent adulthood are periods of peak risk for substance use. For youth with chronic medical conditions (CMCs), substance use may pose special risks from medication interactions, treatment non-adherence, and degradation in self-care. Yet, there have been no nationally representative studies of substance use behaviors during this critical period for medically vulnerable youth. As such, we sought to examine substance use for a national sample of youth with and without CMCs as they transition to adulthood.

Nationally representative, longitudinal data are from 2,144 adolescents interviewed from 1997 to 2011 for the Panel Study of Income Dynamics, Child Development and Transition to Adulthood Supplements. Multivariable logistic regression was used to estimate the prevalence of regular tobacco smoking, binge drinking and recreational marijuana use during the periods of adolescence (13-18) and emergent adulthood (19-26) for youth with and without CMCs, adjusting for potential confounders (age, gender, race/ethnicity, socioeconomic status & psychological distress).

Regular smoking, binge drinking and marijuana use were reported during adolescence for youth with (17.2%, 14.9% and 39.4%, respectively) and without (11.8%, 16.7% and 36.4%, respectively) CMCs, and prevalence increased substantially during emergent adulthood. Multivariable results revealed that relative to youth without any conditions: youth with ADHD (OR: 2.26, p<.01), psychiatric conditions (OR: 3.11, p<.01), heart conditions (OR: 2.94, p<.01), and learning disabilities (OR: 2.46, p<.01) had higher odds of smoking overall, while diabetic youth had lower odds of smoking during adolescence only (OR: 0.08, p=.03). Youth with asthma had higher odds of binge drinking (OR: 1.92, p<.01); and youth with psychiatric conditions had higher odds of marijuana use during adolescence only (OR: 1.73, p<.01).

Estimates suggest that substance use among chronically ill youth during adolescence is a substantial concern, and highlight the need for increased case detection and intervention to address these behaviors and ensure optimal health outcomes.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health
Epidemiology
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
Explain whether alcohol, tobacco, and substance use differs among youth with and without chronic medical conditions during adolescence and young adulthood, periods of peak risk. Assess the implications for clinical practice and public health policy.

Keyword(s): Adolescents, Chronic Disease Management and Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conceptualized the research question, constructed the dataset, conducted all analyses and drafted the abstract.
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.

Back to: 2059.0: Polysubstance use in youth, emerging adults, and other priority populations