Alcohol and marijuana use is common in youth with chronic disease, and alcohol use is associated with nonadherence to treatment, according to a new study published in Pediatrics.
Approximately 1 in 4 American youths are living with a chronic medical condition. The most common substance abused by young people is alcohol, which can lead to adverse medication interactions and difficulty with treatment adherence and self-care. As with healthy youth, alcohol abuse may be associated with poor sleep, smoke exposure, and unprotected or unplanned sex. Marijuana use can lead to airway inflammation, treatment nonadherence, and sleep disturbances. Currently, there are no studies that indicate marijuana has therapeutic utility in young people.
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Elissa Weitzman of Harvard Medical School in Boston, and colleagues sought to fill in knowledge gaps on the prevalence of substance use in chronically ill youths, which may lead to development of preventative strategies.
The investigators conducted a cross-sectional web-based assessment of youth aged 9-18 years who were being treated for cystic fibrosis, asthma, arthritis, type 1 diabetes, or inflammatory bowel disease (IBD). The questionnaire assessed alcohol use, behaviors, marijuana use, and health care interactions (Pediatrics 2015. doi: 10.1542/peds.2015-0722).
Of the 532 youths invited to participate in the study, 403 consented to participate; 51.6% were female, and 75.1% where white. The average age of participants was 15.6 years, and overall they were in good mental health.
Alcohol use within the past year was reported in 30.8%, and older age correlated to alcohol use (P less than .001). Binge drinking was reported in 37.7% of respondents who reported alcohol use within the past year, and 10.4% in the total group. Binge drinking was reported more often in older (P less than .001) and white (P less than .01) chronically ill youth. Better mental health scores were associated with binge drinking (P less than .01).
Marijuana use was reported in 17.2% of the study group and 20.6% of the high school–aged group. Furthermore, marijuana use in chronically ill youth was associated with males, older age, lower socioeconomic status (P less than .01), and poorer mental health (P less than .01). Participants with IBD had higher rates of marijuana use than participants with arthritis or asthma. Almost all youth who reported past-year marijuana use also reported past-year alcohol use, the investigators noted.
Knowledge of alcohol’s potential effects with medications and laboratory results was low, with only 53.1% and 37.2% of high school students answering correctly, respectively. Those who answered incorrectly were 8.53 and 4.46 times more likely to drink and binge drink (P less than .001).
Approximately 8.3% and 32% of the high school–aged participants reported skipping or forgetting to take prescription medications within the past 30 days, respectively. Intentional nonadherence was associated with lower mental health scores (P less than .001). High school–aged youth who admitted to alcohol use within the past year were 1.61 times and 1.79 times more likely to skip and forget their medications, respectively.
Ms. Weitzman and her associates noted that the association of better mental health scores with binge drinking may be related to the social aspect, whereas the association of poorer mental health scores with marijuana may be related to its possible use to improve symptoms.
The authors also pointed out that although nonadherence was associated with alcohol use and poorer mental health scores, it also may be related to health-risking behaviors, poor self-regulation, and the feeling of invulnerability associated with adolescent development.
“Alcohol and marijuana use are prevalent among youth with chronic medical conditions, and drinking is associated with treatment nonadherence. Education and screening of medically vulnerable youth are warranted to ameliorate risk,” they concluded.
The authors reported no disclosures, and the study was supported by an NIH grant.