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

Adolescence is vulnerable period that carry risks for substance use behaviors that may seriously undermine disease management and health status for chronically ill youth. We sought to estimate substance use initiation among a national sample of youth with and without chronic medical conditions (CMCs) as they transition to adulthood.

Longitudinal data are from 2,144 adolescents interviewed in the 1997-2011 Panel Study of Income Dynamics. Multivariable Cox regression was used to estimate the age of onset of regular tobacco smoking, drinking, and recreational marijuana use during the periods of adolescence (13-18) though emergent adulthood (19-26) for youth with and without CMCs, adjusting for potential confounders (age, gender, race/ethnicity, socioeconomic status & psychological distress).

Average age of onset for youth with and without CMCs: 15.8 versus 16.2 years for smoking(p<.05), 14.1 versus 14.2 years for drinking(p>.05), and 15.8 versus 15.3 years for marijuana use(p<.05), respectively. Multivariable results revealed that compared to youth without CMCs, youth with ADHD, learning disabilities, psychiatric and cardiac conditions had earlier age of onset for tobacco smoking (all p<.01). Youth with orthopedic impairments had later initiation of marijuana use than did youth without CMCs (p<.01). Age of onset of alcohol use was not significantly different between youth with and without CMCs.

Findings that youth with CMCs may initiate tobacco use at relatively younger ages than do their healthy peers is concerning in light of the potential for disease exacerbation and health harm. Increased case detection and intervention to address these behaviors and ensure optimal health outcomes is warranted.