Alcohol Use Behaviors and Reasons to Abstain From or Limit Drinking Among Medically Vulnerable Youth

Disease-Tailored Brief Intervention for Alcohol Use Among Youths With Chronic Medical Conditions: A Secondary Analysis of a Randomized Clinical Trial

Importance

In the US, 25% of youths have a chronic medical condition (CMC). Alcohol use is prevalent among youths with a CMC and is associated with treatment nonadherence, simultaneous exposure to contraindicated medications, poor self-care, and elevated rates of progression to heavy and problem use by young adulthood. Preventive interventions targeting these youths are scarce and lack evidence about longer-term risk-stratified effects.

Objective

To evaluate the 12-month effects of a preventive intervention for alcohol use among youths with a CMC reporting baseline no or low-risk alcohol use vs high-risk alcohol use, testing the hypothesis of no difference.

Design, Setting, and Participants

This presepecified secondary analysis used data from a 2-group, parallel randomized clinical trial of the Take Good Care (TGC) intervention. Convenience samples of youths (aged 14-18 years) with a CMC, such as type 1 diabetes, juvenile idiopathic arthritis, or inflammatory bowel disease, were randomly assigned to the intervention or treatment as usual (TAU) between May 11, 2017, and November 20, 2018, and were followed up for up to 12 months. High-risk alcohol use was defined as heavy episodic (binge) alcohol use in the past 3 months and alcohol-related blackouts, injuries, vomiting, or emergency department visits in the past 12 months. Data were analyzed from September 21, 2023, to February 3, 2024.

Interventions

The self-administered, tablet computer-based TGC intervention was developed with patient and expert input, and it delivers disease-tailored psychoeducational content about the effects of alcohol use on overall health, disease processes, and treatment safety and efficacy.

Main Outcomes and Measures

The main outcome was self-reported frequency of alcohol use (in days) over the past 3 months, measured by a single validated question. Maximum likelihood methods incorporating all available data were used assuming data missing at random.

Results

The trial included 451 participants (229 female youths [50.8%]), with a mean (SD) age of 16.0 (1.4) years. Of these youths, 410 (90.9%) participated in the 12-month follow-up. At baseline, 52 youths (11.5%) reported high-risk alcohol use. Among participants with high-risk alcohol use, the observed mean (SD) frequency of alcohol use from baseline to the 12-month follow-up decreased in the intervention group (from 6.3 [4.6] to 4.9 [4.3] days) and increased in the TAU group (from 5.5 [4.9] to 9.0 [5.8] days), with an adjusted relative rate ratio of 0.60 (95% CI, 0.38 to 0.94). There were no group differences among youths reporting no or low-risk alcohol use.

Conclusions and Relevance

In this trial of a brief chronic illness-tailored preventive intervention, medically vulnerable youths with a high risk of alcohol use and harm decreased alcohol use. These findings support the use of a personalized preventive intervention with this group.

Trial Registration

ClinicalTrials.gov Identifier: NCT02803567.

Factors Associated with Substance Use Disorder among High-Need Adolescents and Young Adults in North Carolina

Background

Prevalence of substance use disorders (SUD) is high among adolescents and young adults (AYAs) with complex medical needs. Little is known about risk factors for SUD in this population.

Methods

This retrospective cohort study used electronic health record data from a large academic hospital system (2015-2019) to identify adolescents (aged 10-17) and young adults (aged 18-27) with intellectual/developmental disorders, psychiatric conditions, or complex medical conditions. Logistic regression was used to identify demographic, clinical, and neighborhood-level risk factors associated with SUD in this population.

Results

A total of 149 adolescents and 536 young adults had a SUD diagnosis (6.7% and 20.6%, respectively). Among adolescents, notable risk factors for SUD included age (adjusted odds ratio [aOR] = 1.42, 95% confidence interval [CI] = [1.31, 1.54]), Hispanic ethnicity (aOR = 2.10, 95% CI = [1.10, 3.99]), additional psychoactive medication classes (aOR = 1.27, 95% CI = [1.11, 1.46]), and living in a "high" child opportunity index (COI) (aOR = 2.06, 95% CI [1.02, 4.14]) or a "very high" COI (aOR = 3.04, 95% CI [1.56,5.95]) area. Among young adults, notable risk factors included being male (aOR = 2.41, 95% CI [1.91, 3.05]), being Black (aOR = 1.64, 95% CI [1.28, 2.09]), and additional non-psychoactive (aOR = 1.07, 95% CI [1.03, 1.11]) or psychoactive medication classes (aOR = 1.17, 95% CI [1.07, 1.28]).

Limitations

These descriptive analyses are limited to one large academic hospital system in North Carolina and may not be representative of all high-need AYAs in the state.

Conclusions

Several demographic, clinical, and neighborhood risk factors are associated with SUD in high-need AYAs.

Parent Guidance on Alcohol Use for Youth With Chronic Medical Conditions

PURPOSE

Youth with chronic medical conditions are vulnerable to unique alcohol-related health consequences, yet there are few prevention strategies targeting this group. Youth with chronic medical conditions parents' beliefs and provision of alcohol-related guidance have not yet been explored, which limits the development of effective family-based interventions.

METHODS

We evaluated baseline surveys of youth with chronic medical conditions and their parents (n = 268 dyads) enrolled in a randomized controlled trial of a psychoeducational intervention to reduce alcohol use by youth with chronic medical conditions. Surveys evaluated youth alcohol use, parent beliefs about their child's alcohol use, and parental provision of alcohol guidance, including disease-related and disease-independent (ie, "drinking and driving") topics. Paired bivariate tests (χ 2 , Fisher exact) were used to measure associations between youth with chronic medical conditions alcohol use and parent alcohol-related beliefs and provision of alcohol-related guidance.

RESULTS

In this study of 268 parent-youth dyads, many parents did not provide guidance on disease-specific topics, such as mixing alcohol with medications (47.8%) or risk of flares (37.6%). Furthermore, youth with chronic medical conditions whose parents had expectant beliefs about alcohol use (ie, alcohol use is "inevitable" or "OK with supervision") were more likely to report alcohol use (all P values <0.05).

DISCUSSION

These findings suggest parent beliefs may influence youth with chronic medical conditions alcohol use. Proactive, disease-specific education from medical providers to parents of youth with chronic medical conditions may help to reduce adverse consequences of alcohol use in these vulnerable youth.

Indicators of Healthcare Transition Progress Among College Youth With Type 1 Diabetes

OBJECTIVE

Adolescents with chronic diseases must navigate changing healthcare needs in college and beyond. This study examined the ability of college youth with type 1 diabetes (T1D) to achieve transition milestones and ascertained sociodemographic predictors of a successful healthcare transition (HCT).

METHODS

College youth with T1D were recruited via social media and direct outreach to participate in a web-based study, during which they answered questions about the HCT process. Descriptive statistics and multivariable regression were used to evaluate HCT measures as a function of sociodemographic variables.

RESULTS

Nearly two-thirds of participants (N = 138) had discussions with their providers about changing healthcare needs (65.9%) and transferring care to adult physicians (64.5%); less than one-third (27.9%) discussed obtaining health insurance as an adult. Females were more likely than males to discuss transitioning to adult providers (70.3% vs 40.7%, P < .01). Those covered on a parent's insurance (vs other) plan were more likely to receive help with finding adult providers (79.3% vs 44.4%, P = .04) but less likely to discuss how to obtain health insurance (25.0% vs 61.1%, P < .01). These differences persisted after adjustment.

CONCLUSIONS

Improvement is needed with regard to college youth with T1D becoming autonomous managers of their own care. Gaps were found in their experiences of discussing changing healthcare needs, locating adult providers, and obtaining health insurance-especially among those who were younger, male, and not covered under parental insurance. Efforts to improve the HCT process should focus particularly on these subgroups to advance healthcare delivery in this population.

Differences and Similarities in Motives to Decrease Drinking, and to Drink in General Between Former and Current Heavy Drinkers-Implications for Changing Own Drinking Behaviour

The evidence on why people initiate or cease drinking is vast; however, little is known regarding why people change their frequency and amount of drinking from intense (heavy or dependent drinking) to recreational (with little risk). Therefore, the purpose of this study was to investigate how drinking motives and motives to decrease drinking differ between former heavy drinkers (problematic and dependent), current dependent, and current recreational drinkers. Data were obtained from four groups of individuals (n = 263) using alcohol with different severity. The participants were Polish young adults aged between 18 and 35 years. About 53% of the sample were women. The Alcohol Use Disorder Identification Test (AUDIT) was used to assess the level of drinking; the Drinking Motive Questionnaire-Revised Short Form (DMQ-R SF) was used to assess drinking motives (social, coping, enhancement, and conformity). The reasons for abstaining and limiting drinking (RALD) instrument was used to assess the RALD. Additionally, a set of questions regarding motives to decrease drinking were analysed. The results show that differences were observed between the investigated groups: the current dependent group scored significantly higher on all the dimensions of drinking motives than the current low-risk group and significantly higher on coping, social, and enhancement motives than former heavy drinkers (both groups). The two groups of former heavy drinkers did not differ from each other on drinking motives. The investigated groups differed on the motives to reduce drinking-low-risk users scored the lowest on all the motives, whereas current dependent-the highest. The differences in motives to decrease drinking between current-depended and former heavy drinkers indicate which motives can be associated with the prevention strategies, programmes, and therapeutic approaches.

Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial

Background

College environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating.

Objective

The aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician).

Methods

We recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery.

Results

Of the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol’s impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator.

Conclusions

The intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants’ perceptions of expertise and credibility differed by narrator.

Trial Registration

ClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829

International Registered Report Identifier (IRRID)

RR2-10.1177/1932296819839503

Substance use disorders among youth with chronic physical illness

This study estimated prevalence of substance use disorder in youth with chronic physical illness; quantified magnitudes of association between different chronic physical illnesses with substance use disorder; and, tested whether mental disorder moderates these associations. Data come from 6,377 individuals aged 15-30 years in the Canadian Community Health Survey-Mental Health. Alcohol, cannabis, or other drug use disorder measured using the WHO Composite International Diagnostic Interview 3.0. Individuals with chronic physical illness were more likely to have other drug use disorder compared to healthy controls (2.4% vs. 1.3%; p < .001), but not more likely to have alcohol (7.8% vs. 6.8%) or cannabis use disorder (5.0% vs. 3.6%). Odds of alcohol use disorder were higher among individuals with musculoskeletal conditions, OR = 1.41 (1.03-1.93), but lower among individuals with neurological conditions, OR = 0.49 (0.33-0.72), compared to healthy controls. No associations were found for cannabis use disorder. Odds of other drug use disorder were higher among individuals with endocrine conditions, OR = 2.88 (1.37-6.06). In the presence vs. absence of major depressive disorder, odds for substance use disorder were higher among individuals with respiratory or endocrine conditions. However, odds were lower among individuals with comorbid neurological and major depressive disorders or comorbid respiratory and generalized anxiety disorders. The complexity of the association between chronic physical illness and substance use disorder is compounded when accounting for the moderating effect of mental disorder, which in some contexts, results in a reduced likelihood of substance use disorder in youth with chronic physical illness.