Comparing Substance Use Risks among a National Sample of Youth with and without Chronic Medical Conditions

Adolescence and emergent adulthood are vulnerable periods that carry risks for onset and intensification of substance use behaviors that, while potentially damaging for all youth, may seriously undermine disease management and health status for chronically ill youth. To date, there have been no nationally representative, longitudinal studies of substance use initiation for youth growing up with a chronic medical condition (CMC), despite the paramount importance of early intervention for protecting this group's health. As such, we sought to examine the period prevalence of substance use behaviors for a national sample of youth with and without CMCs as they transition from adolescence to adulthood.

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, a nationally representative, population-based survey. 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 (e.g., diabetes, asthma, ADHD), 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).

While substance use among all US youth remains a major public health problem, prevalence estimates suggest that substance use among chronically ill youth during adolescence is concerning in light of the potential for disease exacerbation and health harm. Additional work to understand risk factors for substance use initiation among chronically ill youth, including by condition, to advance early intervention and response is warranted.