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Weitzman ER, Minegishi M, Wisk LE, Levy S. Substance Use and Educational Impacts in Youth With and Without Chronic Illness. Am J Prev Med 2024; 66:279-290. [PMID: 37802307 DOI: 10.1016/j.amepre.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Alcohol, cannabis, and nicotine are commonly used psychoactive substances that affect adolescent neurocognition. Little is known about the educational impacts of their use on measures of educational performance, participation and problems, especially among youth with a chronic illness who may use these substances to alleviate stress and symptoms. METHODS Adolescents receiving general or subspecialty care were administered an electronic survey from 2016 to 2018. Data were analyzed in 2023. Using modified Poisson models, cross-sectional associations between past 12-month usage of alcohol, cannabis, and/or nicotine and educational impacts were estimated. RESULTS Among 958 adolescents (mean age 16.0 years (SD 1.3), 564 (58.9%) female gender, 445 (46.5%) in subspecialty care), 294 (30.7%), 220 (23.0%), and 126 (13.2%) reported past 12-month use of alcohol, cannabis, and nicotine respectively, while 407 (42.5%) reported ≥1 educational impact, including recent lower grades 210 (21.9%), past 3-month truancy from school 164 (17.1%) or activities 170 (17.7%), and detention 82 (8.6%). Use of cannabis, but not other substances, was associated with negative educational impacts: lower grades (mostly C's/D's/F's), adjusted prevalence ratios [APR, (95% CI)] 1.54 (1.13-2.11); past 3-month truancy from school [2.16 (1.52-3.07)]; detention [2.29 (1.33-3.94)]. The association between cannabis use and any negative educational impact was stronger among adolescents with a chronic illness (p<0.001). CONCLUSIONS Among adolescents, cannabis use was associated with a heightened risk of negative educational impacts, even after controlling for alcohol and nicotine use. Adolescents with chronic illness were especially likely to experience negative educational impacts. Findings underscore need for preventive interventions and messaging to reduce risks.
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Affiliation(s)
- Elissa R Weitzman
- Division of Addiction Medicine, Boston Children's Hospital, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Machiko Minegishi
- Division of Addiction Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Lauren E Wisk
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Sharon Levy
- Division of Addiction Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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2
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Calihan JB, Minegishi M, Levy S, Weitzman ER. Parent Guidance on Alcohol Use for Youth With Chronic Medical Conditions. J Addict Med 2024; 18:75-77. [PMID: 38032736 DOI: 10.1097/adm.0000000000001248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
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.
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Affiliation(s)
- Jessica B Calihan
- From the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA (JC); Division of Addiction Medicine, Boston Children's Hospital, Boston, MA (MM, SJL, ERW); Department of Pediatrics, Harvard Medical School, Boston, MA (SJL, ERW); and Computational Health Informatics Program, Boston Children's Hospital, Boston, MA (ERW)
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3
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Richards CJ, Friedman D, Pinsky H, Gootkind E, Lee H, Yonker L, Georgiopoulos AM. Alcohol and opiate misuse in adults with cystic fibrosis. Pediatr Pulmonol 2023; 58:2535-2542. [PMID: 37294071 DOI: 10.1002/ppul.26541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/10/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND International consensus statements on depression and anxiety in adolescents and adults with cystic fibrosis (awCF) recommend assessment for comorbid substance misuse. However, at CF centers, the frequency and impact of substance misuse have not been well characterized, and best practices for prevention, identification, and evidence-based treatment have not been routinely implemented. METHODS Medical records of 148 awCF over 3 years were reviewed to determine the prevalence of substance misuse (alcohol or opiates) and its relationship with clinical variables and healthcare utilization. Independent sample t test for continuous outcomes and χ2 test for binary outcomes were used to compare groups with and without substance misuse. RESULTS Substance misuse was documented in 28 (19%) awCF, equally distributed between alcohol (n = 13) and opiates (n = 15). Adults with substance misuse were more likely to be male. The prevalence of diagnosed anxiety and depression did not differ significantly between groups, but those with substance misuse had more severe anxiety (Generalized Anxiety Disorder-7 Item [GAD-7]: 10.0 ± 6.1 vs. 3.3 ± 4.4; p < 0.001) and depressive symptoms (Patient Health Questionnaire-9: 10.4 ± 6.5 vs. 4.0 ± 4.8; p < 0.001). Adults with substance misuse had higher annual rates of missed outpatient CF visits, more frequent "sick" visits, more frequent and longer hospitalizations, and a higher mortality rate. CONCLUSIONS In awCF, substance misuse is common and associated with adverse indicators of emotional and physical health, including via proxy of service utilization, suggesting that systematic approaches to addressing substance misuse in CF clinics should be considered. Prospective, longitudinal study is warranted to elucidate the complex relationships between depression, anxiety, substance misuse, and health outcomes in individuals with CF.
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Affiliation(s)
- Christopher J Richards
- Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Deborah Friedman
- Department of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hanna Pinsky
- Pediatric Cystic Fibrosis Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elizabeth Gootkind
- Pediatric Cystic Fibrosis Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hang Lee
- MGH Center for Biostatistics, Boston, Massachusetts, USA
| | - Lael Yonker
- Pediatric Pulmonary, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anna M Georgiopoulos
- Department of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Annett RD, Ansari AY, Blackshear C, Bender BG. Predicting Young Adult Tobacco, Drug and Alcohol Use Among Participants in the CAMP Trial. J Clin Psychol Med Settings 2022; 29:739-749. [PMID: 35013874 DOI: 10.1007/s10880-021-09841-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/26/2022]
Abstract
The development of substance abuse in youth with asthma have seldom been examined with longitudinal research. The prospective and well-characterized CAMP cohort provides outcome data on youth with asthma over 13 years. This manuscript seeks to determine the contributions of asthma features and child behavioral/emotional functioning to subsequent tobacco, alcohol, and drug use in early adulthood. Childhood smoking exposures as well as parent report and youth report of substance use were prospectively assessed concurrently with assessments of asthma symptoms, study medication, and lung development. Logistic regression models evaluated predictors of adolescent and young adult tobacco, alcohol, and drug use. Use of tobacco products was reported by 33% of youth with mild/moderate asthma. Tobacco use was significantly associated with self-reported externalizing behaviors. Early life passive smoke exposure, especially in utero exposure, makes a significant contribution to tobacco use (OR1.58). Greater risk for tobacco use is conveyed by self-reported externalizing behaviors, which are consistently robust predictors of any future use of tobacco products, alcohol and drugs. These findings provide evidence for health care providers to use routine behavioral screening in youth with asthma.
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Affiliation(s)
- Robert D Annett
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, 87106, USA.
| | - Abu Yusuf Ansari
- Department of Data Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Chad Blackshear
- Department of Data Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Bruce G Bender
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
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Vergunst F, Chadi N, Orri M, Brousseau-Paradis C, Castellanos-Ryan N, Séguin JR, Vitaro F, Nagin D, Tremblay RE, Côté SM. Trajectories of adolescent poly-substance use and their long-term social and economic outcomes for males from low-income backgrounds. Eur Child Adolesc Psychiatry 2022; 31:1729-1738. [PMID: 34059981 DOI: 10.1007/s00787-021-01810-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/21/2021] [Indexed: 01/01/2023]
Abstract
Substance abuse is a significant public health concern that disproportionately burdens males and low-income communities. This study examined (1) longitudinal profiles of male adolescent poly-substance use and (2) their association with social and economic participation across early adulthood. Drawing on a cohort of males (n = 890) from low-income neighborhoods, we used group-based multi-trajectory modeling to identify profiles of poly-substance use (alcohol, tobacco, cannabis, illicit drugs) from age 13-17 years. Regression models were used to link substance use profiles to high school graduation, criminal convictions, personal and household earnings, welfare receipt and partnership from age 19-37 years, obtained from administrative records. Child IQ, family adversity and behavioral problems were adjusted for. Four poly-substance use profiles were identified: abstinent (n = 128, 14.4%), late-onset (n = 412, 46.5%), mid-onset (n = 249, 28.1%), and early-onset (n = 98, 11.1%). Relative to the late-onset (reference) group, participants in the early-onset profile were 3.0 times (95%CI = 1.68-5.53) more likely to have left school without a diploma, 2.7 times (95% CI = 1.56-4.68) more likely to have a criminal conviction by age 24 years, earned 10,185 USD less (95% CI = - 15,225- - 5144) per year at age 33-37 years and had 15,790 USD lower (95% CI = - 23,378- - 8218) household income at age 33-37 years, a 1.3 times (95%CI = 1.15-1.57) higher incidence of annual welfare receipt and a 24% (95% CI = 5-40) lower incidence of marriage/cohabitation from age 18-35 years. We show that adolescent-onset poly-substance use by age 13 is associated with poor social and economic outcomes. Delaying the onset of substance use and reducing exposure to additional substance classes has potential for high societal cost savings.
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Affiliation(s)
- Francis Vergunst
- Université de Montréal, Montréal, Canada
- Ste-Justine Hospital Research Center, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Nicholas Chadi
- Université de Montréal, Montréal, Canada.
- Ste-Justine Hospital Research Center, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Massimiliano Orri
- Ste-Justine Hospital Research Center, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- Bordeaux Population Health Research Centre, INSERM U1219, Université de Bordeaux, Bordeaux, France
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | | | - Natalie Castellanos-Ryan
- Université de Montréal, Montréal, Canada
- Ste-Justine Hospital Research Center, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Jean R Séguin
- Université de Montréal, Montréal, Canada
- Ste-Justine Hospital Research Center, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Frank Vitaro
- Université de Montréal, Montréal, Canada
- Ste-Justine Hospital Research Center, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- School of Psycho-Education, University of Montreal, Montreal, Canada
| | | | - Richard E Tremblay
- Ste-Justine Hospital Research Center, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- Department of Pediatrics and Psychology, University of Montreal, Montreal, Canada
| | - Sylvana M Côté
- Université de Montréal, Montréal, Canada
- Ste-Justine Hospital Research Center, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- Bordeaux Population Health Research Centre, INSERM U1219, Université de Bordeaux, Bordeaux, France
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Levy S, Wisk LE, Minegishi M, Lunstead J, Weitzman ER. Pediatric Subspecialist Alcohol Screening Rates and Concerns About Alcohol and Cannabis Use Among Their Adolescent Patients. J Adolesc Health 2022; 71:S34-S40. [PMID: 36122967 DOI: 10.1016/j.jadohealth.2022.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/25/2022] [Accepted: 03/10/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Pediatric specialty care provides an opportunity to screen for and address patient substance use; however, little is known about providers' screening rates, their opinions regarding substance use harms, or the potential marijuana to be used as a medication. METHODS We surveyed national convenience samples of pediatric endocrinologists (N = 142) and rheumatologists (N = 83) and used descriptive statistics and multivariate logistic regression to examine alcohol screening rates, barriers, and for medical use of marijuana, differences between subspecialist concerns. RESULTS In all, 36.4% of providers reported screening adolescent patients annually or more, and a majority expressed concerns about impacts on disease management (80.0%/80.0%) and symptom management (69.3%/53.3%) from alcohol and marijuana, respectively. Nearly equal proportions disagreed (30.2%), were neutral (34.7%), or agreed (35.1%) that some patients would benefit from medical marijuana, although majorities were not comfortable recommending marijuana (62.7%) and did not believe marijuana is standardized enough to be used as medication (57.8%). DISCUSSION Fewer than half of the subspecialists in our study routinely screen their adolescent patients for substance use, although many have concerns regarding the impacts of alcohol and marijuana use on their patients. Education and training on best practice could help to increase screening rates. There is agreement that marijuana is not standardized enough to be used as a medication. There is also a broad range of opinions regarding the pharmaceutical potential of marijuana and concerns about the impact of marijuana on underlying chronic medical conditions, which should be considered as marijuana policy continues to evolve.
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Affiliation(s)
- Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Lauren E Wisk
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Machiko Minegishi
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Julie Lunstead
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Elissa R Weitzman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
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Weitzman ER, Wisk LE, Minegishi M, Cox R, Lunstead J, Brogna M, Levy S. Effects of a Patient-Centered Intervention to Reduce Alcohol Use Among Youth With Chronic Medical Conditions. J Adolesc Health 2022; 71:S24-S33. [PMID: 36122966 DOI: 10.1016/j.jadohealth.2021.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Alcohol poses unique risks for youth with chronic medical conditions (YCMC) yet many drink. Preventive interventions targeting YCMC are scarce. METHODS YCMC with type 1 diabetes, juvenile idiopathic arthritis, systemic lupus erythematosus, or inflammatory bowel disease were recruited and randomized to trial the effects of a self-administered condition-tailored psychoeducational intervention on frequency in days of past 3-month alcohol use, alcohol-related risk perceptions, and knowledge. Changes in outcomes over time were measured and compared by treatment arm using multivariate mixed effects models. RESULTS Among N = 418 participants (average age 16.0 years, 52.2% female, 84.7% white, 90.7% non-Hispanic), 24.2% reported past-year alcohol use at baseline. Alcohol-related knowledge increased overall and was greater for the intervention group (adjusted improvement in knowledge score +7.70, 95% confidence interval [CI] 2.92-12.48). By 6-month follow-up, the percentage of youth reporting any alcohol use is risky/dangerous increased among intervention arm participants from 41.5% to 45.4% at baseline and decreased from 38.9% to 37.4% among controls (adjusted intervention effect odds ratio 1.79, 95% confidence interval 1.02-3.13). Overall, frequency of drinking increased over time from 3.72 to 4.52 days on average, with no differences by treatment group. Among female drinkers, the predicted mean frequency of drinking days declined in the intervention group (4.11-3.33) and increased among controls (2.82-4.55) (adjusted intervention effect rate ratio .50, 95% confidence interval .25-.99). CONCLUSIONS Exposure to a chronic illness-tailored psychoeducational intervention targeting alcohol use increased knowledge and perceived risk and, among females, reduced alcohol use. Promising results merit future work to optimize the model for both males and females.
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Affiliation(s)
- Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Lauren E Wisk
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Division of General Internal Medicine and Health Services Research, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Machiko Minegishi
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Rachele Cox
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Julie Lunstead
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts
| | - Melissa Brogna
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts
| | - Sharon Levy
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts
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Xiao N, Chai H, Omoloja A. Substance use among adolescents and young adults with chronic kidney disease or kidney failure. Pediatr Nephrol 2021; 36:3585-3593. [PMID: 33686466 DOI: 10.1007/s00467-021-05001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/31/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
Substance use, a significant public health issue, is well described in the adult chronic kidney disease (CKD) population. Knowledge about substance use in the adolescent and young adult (AYA) CKD population such as prevalence, impact on kidney function, medication adherence, and psychosocial well-being remain largely unknown. Awareness of and inquiring about substance use is paramount to providing evidence-based care and preparation to transition to adult-focused health services. The authors in this review identify commonly used substances (alcohol, tobacco, marijuana, etc.) and how they impact kidney function and care of the AYA with CKD or kidney failure. Recommendations for screening and intervention strategies are provided.
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Affiliation(s)
- Nianzhou Xiao
- Department of Nephrology, Valley Children's Healthcare, Madera, CA, USA
| | - Hua Chai
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Abiodun Omoloja
- Department of Pediatrics, Wright State University, Dayton, OH, USA.
- Division of Nephrology, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA.
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Wisk LE, Magane KM, Nelson EB, Tsevat RK, Levy S, Weitzman ER. Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial. J Med Internet Res 2021; 23:e26418. [PMID: 34591022 PMCID: PMC8517820 DOI: 10.2196/26418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/15/2021] [Accepted: 05/06/2021] [Indexed: 01/24/2023] Open
Abstract
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
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Affiliation(s)
- Lauren E Wisk
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States.,Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Kara M Magane
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Eliza B Nelson
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Rebecca K Tsevat
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Sharon Levy
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
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Alcohol Use Behaviors and Reasons to Abstain From or Limit Drinking Among Medically Vulnerable Youth. J Addict Med 2021; 14:311-318. [PMID: 31985512 DOI: 10.1097/adm.0000000000000603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Youth with chronic medical conditions (YCMC) use alcohol at levels similar to their healthy peers but face elevated risk for adverse health consequences. As salient reasons to abstain from or limit drinking (RALD) among YCMC are unknown, we sought to identify clusters of RALD and test associations with use behaviors. METHODS Eligible YCMC (ages 9-18) recruited from outpatient clinics reported their use behaviors and importance of potential RALD. Cluster analysis was used to discern RALD patterns, which were examined as predictors of alcohol use using multivariate regression. RESULTS Among 398 participants, 30.9% reported past year alcohol use. Concerns about impacts on medications, school, and disease status were the most frequently endorsed RALD; prior negative experiences with alcohol and family history were the least frequently endorsed. Five RALD clusters were identified for all YCMC and 2 for recent drinkers. Compared to the cluster with high endorsement of multiple general and health-related RALD, those predominantly citing concerns about addiction and those not strongly endorsing any RALD consistently reported greater alcohol use. Among recent drinkers, the cluster characterized by low concern across multiple RALD also consistently reported greater alcohol use compared to their counterparts expressing moderate concern. CONCLUSIONS For YCMC, RALD are complex but endorsement of multiple general and health-related RALD is associated with less use, and health concerns are especially prevalent. More research is needed to understand how salient RALD can inform tailored interventions that aim to delay and reduce substance use and improve health outcomes for YCMC.
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Levy S, Tennermann N, Marin AC, Wiseblatt A, Shrier LA, Garvey K, Dedeoglu F, Fishman LN, Weitzman ER. Safety Protocols for Adolescent Substance Use Research in Clinical Settings. J Adolesc Health 2021; 68:999-1005. [PMID: 32994123 DOI: 10.1016/j.jadohealth.2020.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Research involving adolescent risk behaviors must balance data confidentiality with participant safety when risky behaviors are revealed. This report details a safety protocol and reports the experience of two contemporaneous studies that used it with variant safety thresholds. METHODS We developed a safety protocol for research with adolescent patients and used it in two concurrent studies of adolescent patients, aged 14-18 years. Study "PC" recruited participants from a primary care adolescent medical clinic (N = 490), and Study "SP" recruited participants from subspecialty pediatric clinics (N = 434); both studies involved a similar self-administered assessment of health behaviors. The protocol sets thresholds for clinical intervention (positive safety flags) for past 3-month heavy alcohol consumption (Study PC: 10 or more drinks and Study SP: "binge-"level drinking), illicit drug use other than marijuana and alcohol in combination with a substance other than marijuana, and sets a positive screen for depression. We examined the rates of positive safety flags in both protocol settings, used significance testing to describe demographic differences between participants with and without positive flags in both studies, and described clinician experiences with protocol implementation. RESULTS In studies PC/SP, .6%/8.8% of participants were flagged for heavy alcohol consumption, respectively; .2%/0% for illicit drug use, 2.2%/.7% for combination substance use, and 14.9%/4.8% for depression. Some clinicians found managing positive flags challenging, although both studies completed recruitment on time and without serious adverse events. CONCLUSIONS The protocol was feasible in clinical settings. The findings and experiences documented in this report could be useful for future protocols.
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Affiliation(s)
- Sharon Levy
- Adolescent Substance use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Nicole Tennermann
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
| | - Alexandra C Marin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Aria Wiseblatt
- Adolescent Substance use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts
| | - Lydia A Shrier
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Katharine Garvey
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Fatma Dedeoglu
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Immunology, Rheumatology Program, Boston Children's Hospital, Boston, Massachusetts
| | - Laurie N Fishman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts
| | - Elissa R Weitzman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
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12
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Hayde N. Substance use and abuse in pediatric transplant recipients: What the transplant provider needs to know. Pediatr Transplant 2021; 25:e13877. [PMID: 33105048 DOI: 10.1111/petr.13877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/27/2020] [Accepted: 09/17/2020] [Indexed: 12/22/2022]
Abstract
Substance abuse is infrequently addressed during pre- and post-transplant care. However, the significant increase in the use of nicotine- and marijuana-containing products in the general and transplant adolescent population is concerning. In addition, alcohol use/abuse remains prevalent in the US population as it is highly accessible. Pediatric transplant providers should be prepared to screen for the use of any of these substances (eg, alcohol, nicotine, marijuana, cocaine, opiates, amphetamines) and to counsel them about the dangers of substance use and abuse including the unique dangers of the substances as a transplant recipient. Formal screening tools (in children as young as 9 years) should always be used as casual assessment of substance abuse has a high failure rate. This review summarizes the substances most commonly used in adolescent transplant recipients and the approach that transplant providers should take in order to prevent, decrease, or halt use in this patient population.
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Affiliation(s)
- Nicole Hayde
- Children's Hospital at Montefiore, Bronx, NY, USA
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13
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Luther AW, Reaume SV, Qadeer RA, Thompson K, Ferro MA. Substance use disorders among youth with chronic physical illness. Addict Behav 2020; 110:106517. [PMID: 32619867 DOI: 10.1016/j.addbeh.2020.106517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 02/08/2023]
Abstract
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.
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14
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Levy S, Weitzman ER, Marin AC, Magane KM, Wisk LE, Shrier LA. Sensitivity and specificity of S2BI for identifying alcohol and cannabis use disorders among adolescents presenting for primary care. Subst Abus 2020; 42:388-395. [DOI: 10.1080/08897077.2020.1803180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children’s Hospital, Boston, MA, USA
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Elissa R. Weitzman
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA, USA
| | - Alexandra C. Marin
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Kara M. Magane
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Lauren E. Wisk
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Lydia A. Shrier
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
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15
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Substance Use in Adolescents and Young Adults With Inflammatory Bowel Diseases: An Exploratory Cluster Analysis. J Pediatr Gastroenterol Nutr 2019; 69:324-329. [PMID: 30985442 DOI: 10.1097/mpg.0000000000002365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Adolescents and young adults (AYAs) with chronic illnesses use substances at similar, if not greater, rates compared to healthy peers. The present study aimed to examine rates and patterns of tobacco use, marijuana use, and binge drinking in AYAs with inflammatory bowel diseases. We expected that substance use would be associated with poorer physical health, psychosocial functioning, and disease management. METHODS One hundred thirty-two AYAs completed a single set of surveys assessing demographics, disease activity, healthcare utilization, health-related quality of life (HRQoL), inflammatory bowel disease-specific self-efficacy, adherence barriers, disease management skills, and substance use in the last 30 days (eg, tobacco use, marijuana use, binge drinking). Exploratory cluster analyses, followed by chi-square tests and analyses of variance examined patterns of substance use and correlates of cluster membership. RESULTS Four patterns emerged from the sample: Global Users (n = 17), Marijuana Users Engaging in Binge Drinking (n = 18), Exclusive Binge Drinkers (n = 21), and Global Abstainers (n = 76). Groups differed by age, gender, disease activity, healthcare utilization, HRQoL, self-efficacy, and adherence barriers with medium and large effect sizes (P < .05). CONCLUSIONS Older age, male gender, active disease, at least 1 hospitalization in the past year, low self-efficacy, low HRQoL, and high adherence barriers were significantly more likely for those reporting multisubstance use. In addition, all those reporting both marijuana use and binge drinking also reported tobacco use. Future research ought to examine these associations longitudinally and throughout the transition to adult care.
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Abstract
PURPOSE OF REVIEW The transition of patients from pediatric to adult centered care represents not only the means to transfer medical care to a group of providers who specialize in adult care but also is part of the process of the transfer of healthcare responsibility from the family to a patient. The intent of this review is to provide a summary of some of the important studies published in the past 2 years that advance this knowledge. RECENT FINDINGS Progress has been made in the recognition of the process of transition, including developing tools to assess transition readiness, improving routes of communication along with patient education. Other studies provided information on patients' preferences for information seeking, types of family interactions, and factors that improved transition success. SUMMARY In general, reported clinics and programs did demonstrate improvements in adherence, clinic retention, and even quality of life. Further studies should focus on clinical outcomes of transition programs and risk assessment for transitioning patients.
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17
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Lunstead J, Weitzman ER, Harstad E, Dedeoglu F, Gaffin JM, Garvey KC, MacGinnitie A, Rufo PA, Fishman LN, Wisk LE, Levy S. Screening and Counseling for Alcohol Use in Adolescents With Chronic Medical Conditions in the Ambulatory Setting. J Adolesc Health 2019; 64:804-806. [PMID: 31122509 PMCID: PMC6540811 DOI: 10.1016/j.jadohealth.2019.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE We seek to determine how youth with chronic medical conditions experience alcohol screening and counseling. METHODS Adolescents with type I diabetes, juvenile idiopathic arthritis, moderate persistent asthma, cystic fibrosis, attention deficit hyperactivity disorder, or inflammatory bowel disease were surveyed. Descriptive statistics and regression analysis quantified rates of asking and counseling about alcohol. RESULTS Of 390 participants (75.1% white/non-Hispanic, 51.8% female, average age 16.4 years), 70% reported being asked about their alcohol use by a healthcare provider, and 76% reported receiving at least one message regarding alcohol and health. Of past year drinkers, 54% disclosed use to their provider. Only 2.0% of youth reported receiving the message "I should not drink." CONCLUSIONS Most youth with chronic medical conditions were asked and counseled about alcohol use although few heard unambiguous recommendations to avoid alcohol consumption.
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Affiliation(s)
- Julie Lunstead
- Adolescent Substance Use and Addicition Program, Boston Children’s Hospital,Division of Developmental Medicine, Boston Children’s Hospital
| | - Elissa R. Weitzman
- Department of Pediatrics, Harvard Medical School,Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital,Computational Health Informatics Program, Boston Children’s Hospital
| | - Elizabeth Harstad
- Division of Developmental Medicine, Boston Children’s Hospital,Department of Pediatrics, Harvard Medical School
| | - Fatma Dedeoglu
- Department of Pediatrics, Harvard Medical School,Division of Immunology, Rheumatology Program, Boston Children’s Hospital
| | - Jonathan M. Gaffin
- Department of Pediatrics, Harvard Medical School,Division of Respiratory Diseases, Boston Children’s Hospital
| | - Katherine C. Garvey
- Department of Pediatrics, Harvard Medical School,Division of Endocrinology, Boston Children’s Hospital
| | - Andrew MacGinnitie
- Department of Pediatrics, Harvard Medical School,Division of Immunology, Boston Children’s Hospital
| | - Paul A. Rufo
- Department of Pediatrics, Harvard Medical School,Division of Gastroenterology, Boston Children’s Hospital
| | - Laurie Newman Fishman
- Department of Pediatrics, Harvard Medical School,Division of Gastroenterology, Boston Children’s Hospital
| | - Lauren E. Wisk
- Department of Pediatrics, Harvard Medical School,Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
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18
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Wisk LE, Nelson EB, Magane KM, Weitzman ER. Clinical Trial Recruitment and Retention of College Students with Type 1 Diabetes via Social Media: An Implementation Case Study. J Diabetes Sci Technol 2019; 13:445-456. [PMID: 31010315 PMCID: PMC6501540 DOI: 10.1177/1932296819839503] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND We sought to quantify the efficiency and acceptability of Internet-based recruitment for engaging an especially hard-to-reach cohort (college-students with type 1 diabetes, T1D) and to describe the approach used for implementing a health-related trial entirely online using off-the-shelf tools inclusive of participant safety and validity concerns. METHOD We recruited youth (ages 17-25 years) with T1D via a variety of social media platforms and other outreach channels. We quantified response rate and participant characteristics across channels with engagement metrics tracked via Google Analytics and participant survey data. We developed decision rules to identify invalid (duplicative/false) records (N = 89) and compared them to valid cases (N = 138). RESULTS Facebook was the highest yield recruitment source; demographics differed by platform. Invalid records were prevalent; invalid records were more likely to be recruited from Twitter or Instagram and differed from valid cases across most demographics. Valid cases closely resembled characteristics obtained from Google Analytics and from prior data on platform user-base. Retention was high, with complete follow-up for 88.4%. There were no safety concerns and participants reported high acceptability for future recruitment via social media. CONCLUSIONS We demonstrate that recruitment of college students with T1D into a longitudinal intervention trial via social media is feasible, efficient, acceptable, and yields a sample representative of the user-base from which they were drawn. Given observed differences in characteristics across recruitment channels, recruiting across multiple platforms is recommended to optimize sample diversity. Trial implementation, engagement tracking, and retention are feasible with off-the-shelf tools using preexisting platforms.
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Affiliation(s)
- Lauren E. Wisk
- Division of Adolescent/Young Adult
Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard
Medical School, Boston, MA, USA
- Division of General Internal Medicine
& Health Services Research, David Geffen School of Medicine at the University of
California, Los Angeles, Los Angeles, CA, USA
- Lauren E. Wisk, PhD, Division of General
Internal Medicine & Health Services Research, David Geffen School of
Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Ste
850, Los Angeles, CA 90024, USA.
| | - Eliza B. Nelson
- Division of Adolescent/Young Adult
Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Kara M. Magane
- Division of Adolescent/Young Adult
Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Elissa R. Weitzman
- Division of Adolescent/Young Adult
Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard
Medical School, Boston, MA, USA
- Computational Health Informatics
Program, Boston Children’s Hospital, Boston, MA, USA
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19
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Weitzman ER, Salimian PK, Rabinow L, Levy S. Perspectives on substance use among youth with chronic medical conditions and implications for clinical guidance and prevention: A qualitative study. PLoS One 2019; 14:e0209963. [PMID: 30673730 PMCID: PMC6343873 DOI: 10.1371/journal.pone.0209963] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/16/2018] [Indexed: 02/02/2023] Open
Abstract
Increasing numbers of youth globally live with a chronic illness. These youth use alcohol and marijuana at levels equal to or greater than their healthy peers and, when using, are at elevated risk for regular or problem use and adverse consequences to their condition. Little is known about whether behavioral theories commonly invoked to explain adolescent substance use apply to this group, limiting our ability to develop, tailor and target preventive interventions. We interviewed youth ages 16-19 years in care for a chronic disease to gain knowledge of this group's perspectives on substance use risk, decision-making, and preferences for clinical guidance. Interviews were transcribed and thematically analyzed. Three principal themes emerged: first, having a chronic disease frames understanding of and commitment to health protecting behaviors and impacts decisions to avoid behaviors that carry risks for disease complications and flares; second, developmental impulses typical of adolescence can amplify an adolescent's propensity to take risks despite medical vulnerability and direct youth toward maladaptive choices to mitigate risk; and third, poor knowledge about effects of substance use on specific features of a disease shapes perceived risk and undermines health protecting decisions. Youth navigate these issues variously including by avoiding substance use at a specific time or entirely, using while cognitively discounting risks and/or adjusting treatment outside of medical advice. Their perceptions about substance use are complex and reveal tension among choices reflecting a chronic illness frame, developmental impulses, and knowledge gaps. Delivery of targeted guidance in healthcare settings may help youth navigate this complexity and connect patient-centered goals to optimize health with health protecting behavioral decisions.
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Affiliation(s)
- Elissa R. Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Parissa K. Salimian
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Lily Rabinow
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Sharon Levy
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
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