- Email: [email protected]
Validity and Reliability of Alcohol and Marijuana Use Susceptibility Among Latino Youth
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Poster Symposia / 60 (2017) S21eS38
Conclusions: Prosocial peers and emotional engagement to school were consistently associated with lower odds of behaviors that can undermine healthy development and school success, highlighting the importance of relationships within the school environment for students’ social and behavioral health. In contrast, peer connectedness was positively associated with several risk behaviors. Programs that provide opportunities for diverse adolescents to develop capacities and competencies for meaningful engagement in learning and to experience school as a positive environment are key elements of efforts designed to reduce health and educational disparities. Fostering positive student competencies and school engagement may be promising approaches for promoting school success and well-being among vulnerable students in urban and suburban settings. Sources of Support: Not applicable. 56. TRENDS IN SUBSTANCE USE AMONG MULTIRACIAL ADOLESCENTS: FINDINGS FROM THE NATIONAL SURVEY ON DRUG USE AND HEALTH, 2005-2014 Marvin So, MPH. Emory University School of Medicine.
Purpose: Although the mixed-race population is the fastest growing segment of the U.S. population (Humes, Jones, & Ramirez, 2011), little is known about the substance use behaviors of bi- and multi-racial people, particularly adolescents. Extant research has focused on White and monoracial minority youth (Clark, Doyle, & Clincy, 2013); what does exist suggests that multi-race individuals have substance use prevalence and initiation rates that are intermediate to and distinct from corresponding monoracial counterparts (Clark, Nguyen, & Kropko, 2013). Given the salience of racial/ ethnic self-identification during adolescence, investigation of substance use among the mixed-race group overall and stratified by specific race combinations is warranted. This study examined nationwide substance use among adolescents age 12-17 who indicated a racial/ethnic identity of two or more races. Methods: We used data from the National Survey on Drug Use and Health, a cross-sectional, nationally-representative survey of people aged 12 and above that examines levels and patterns of substance use in the U.S. Using bivariate and multivariate statistics, we estimated the age-, gender-, and race combination-specific prevalence of past month (i.e., current) substance use for several drugs. Prevalence ratios were calculated to determine mixed-race estimates relative to national averages, across time and socioeconomic status. This included use of marijuana, cigarettes, alcohol, and prescription pain relievers for non-medical reasons, as well as overall use. We limited race combination-specific analyses to groups with sufficient sample size: White-Black, White-Asian, and White-American Indian/Alaska Native (all with crosstabulations for Hispanic origin). Results: Overall prevalence of substance use for mixed-race adolescents has been consistently higher than the national average for the past decade. Prevalence for both groups declined from 2005-2014, with prevalence ratios remaining consistent throughout. Current marijuana and alcohol use fluctuated over the decade, with a recent trend below the national average.
Current cigarette and non-medical prescription pain reliever use remained elevated and persist, with prevalence ratios between (PR: 1.3-2.4) over the study period. We observed increasing prevalence ratios for overall substance use and all four specific substances, for males, older adolescents, and low-income subgroups over time. Prevalence ratios for specific race combinations remained consistent over time, but remain high, particularly for White-Black people (PR: 1.6-2.2) and White-American Indian/ Alaska Natives (PR: 2.3-3.8). Conclusions: Although mixed-race individuals constitute a small, heterogeneous subpopulation, clear and persistent disparities in measures of substance use, particularly for cigarettes and prescription pain relievers, among these youth are concerning. Contextualized with what is known about elevated mental health problems in this population (Whaley, et al., 2006), our findings suggest that extant research on racial/ethnic health disparities has hitherto neglected the growing mixed-race adolescent population. Breaking down the “general multiracial group” (Charmaraman, et al., 2014) is an important next step for advancing understanding of the behavioral health needs of specific multiracial groups. We discuss the implications of racial socialization and code-switching for disentangling the relationship between mixed-race identity and substance use, and offer research needed to formulate prevention and treatment programs for this group. Sources of Support: Not applicable. 57. VALIDITY AND RELIABILITY OF ALCOHOL AND MARIJUANA USE SUSCEPTIBILITY AMONG LATINO YOUTH Diego Garcia-Huidobro, MD, PhD 1, Cynthia Davey, MS 1, Maria Veronica Svetaz, MD, MPH, FSAHM 2, MIchele Allen, MD, MPH, FSAHM 1. 1
University of Minnesota; 2Aqui Para Ti, Hennepin County Medical Center.
Purpose: Latino youth experience high substance use rates that for some ages and substances surpass other race/ethnic groups. Preventive interventions are critical to reduce substance use inequities experienced by Latino youth. An important step is to develop sound measures that will identify youth at-risk before engaging in these behaviors. Measures of youth smoking susceptibility have been evaluated for Latino adolescents, however measures to identify Latino teens who are at risk of alcohol and other illicit substance use are needed. This study aims to determine the test-retest reliability and validity of measures to identify alcohol and marijuana use susceptibility of Latino adolescents. Methods: Padres Informados, Jovenes Preparados was a randomized trial of a parenting intervention to prevent tobacco and illicit substance use on Latino adolescents aged 10 to 14. Only participants randomized to the control group (n¼172), and reported complete data at baseline, 4-month, and 10-month follow ups (n¼139, 81%) were included in this study. Youth were asked 3 questions to determine alcohol susceptibility: 1) Do you think you will try to drink alcohol (more than a few sips) soon?, 2) If one of your best friends were to offer you a drink of alcohol would you drink it?, and 3) Do you think you will be having a drink of alcohol one year from now? Youth were classified as susceptible if they answered yes to any of those questions. Similar questions and
Poster Symposia / 60 (2017) S21eS38
scoring system were used to determine marijuana use susceptibility. Kappa coefficient (95% confidence intervals) between baseline and 4-month susceptibility assessments were used to determine test-retest reliability. Prediction of 10-month substance use by baseline substance use susceptibility adjusted by youth age and gender were used to determine scale validity. Results: Participating youth were mostly born in the US, had a mean age of 12 years, and had a similar proportion of boys and girls. Baseline prevalence of alcohol use susceptibility was 18.2% and marijuana use susceptibility 5.7%. 10-month prevalence of alcohol use was 17.4% and marijuana use 3.7%. Kappa coefficients between baseline and 4-month reports were 0.52 (95% CI: 0.35, 0.70) and 0.81 (95% CI: 0.61, 1.00) for alcohol and marijuana susceptibility. Youth susceptible to alcohol use had 7.63 (95% CI: 2.49, 23.3) odds of using alcohol after 10 months compared to non-susceptible youth, and youth susceptible to marijuana had 43.76 (95% CI: 4.84, 395.9) odds of using marijuana after 10 months compared to non-susceptible adolescents. Conclusions: We report reliable and valid measures of alcohol and marijuana use that can be used to evaluate prevention interventions targeting Latino youth. Sources of Support: National Cancer Institute (U54CA153603) and National Research Service Award (NRSA) in Primary Medical Care, US Department of Health and Human Services. 58. SUBSEQUENT SEXUALLY TRANSMITTED INFECTIONS AMONG ADOLESCENT AND YOUNG ADULT WOMEN USING LONG ACTING REVERSIBLE CONTRACEPTIVES Anthony W. Robateau-Colon, BS 1, Kathy Tomaszewski, BSN 2, Harolyn Belcher, MD, MPH, FSAHM 3, Maria Trent, MD, MPH, FSAHM 2. 1
Ponce Health Sciences University; 2Johns Hopkins Medicine; 3 Kennedy Krieger Institute/Johns Hopkins Medicine. Purpose: Long Acting Reversible Contraceptives (LARC) are recommended a first line of contraceptive option in adolescents and young adult women. However, a recent study of US high school students demonstrated that LARC users were significantly less likely to use condoms and more likely to have multiple sex partners, putting LARC users at potentially greater risk for sexually transmitted infections (STI’s). Given the disproportionately high rate of STI’s among African American adolescents in urban centers; efforts to clarify the relationship between LARC use and STI outcomes is critical. The objective of this study is to determine 1) the rates of STI screening and positivity among sexually active urban youth who had a LARC (intrauterine device or implant) placed for contraceptive management and 2) the relationship between their pre-LARC STI history and subsequent STI infections post-LARC placement among those who were tested. Methods: This study utilized a retrospective cohort analysis of programmatic data collected to track referrals, appointments, and visit outcomes for a novel, clinic-based quality improvement program launched in 2011 within an urban academic practice to enhance LARC access and uptake among young women in Baltimore, Maryland. Programmatic data were augmented by review of the electronic medical record (EMR) to document preand post-LARC STI diagnoses (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), and behaviorally acquired human immunodeficiency virus (HIV). Bivariate analyses were conducted to examine the association
S33
between variables of interest (e.g., parity, insurance status, and Pre-and Post-LARC STI’s) using STATA Intercooled version 13 software. Results: Of 136 patients who had 1 year of follow-up, 80 met criteria for inclusion in the analysis by maintaining the LARC for a year (N¼22 excluded) and having STI screening or testing during the 1-year follow-up period (N¼34 additional cases excluded). The mean age of participants was 17.6 (SD¼2.5), 96.2% (n¼77) were African American, 87.5% (n¼70) had public insurance, 7.5% (n¼6) private and 5% (n¼4) uninsured. Thirty percent (n¼24) had a history of STI’s and 15% (n¼12) had a history of pregnancy. The post-LARC rate of STI’s was lower, 21.2% (CT¼ 58.8%, NG¼0% TV ¼X¼41.2%). Of those who did not have a Pre-LARC STI history, 17.9% (n¼10) acquired an STI following LARC. The rate of STI’s among those with a Pre-LARC STI history was 29.2% (n¼7). The difference in the rates of STI’s did not reach statistical significance after adjusting for parity, age of insertion, and insurance. Conclusions: Adolescent girls having LARCs placed in this urban clinical program have high rates of STIs both before and following LARC placement. 30% of those with a LARC in place for a year were not rescreened for STIs. While there was a trend towards higher rates of post-LARC STI among girls with a Pre-LARC STI history, this finding did not reach statistical significance. Close follow-up of LARC users including routine STI screening to follow STI and fertility outcomes is warranted to determine the need for additional risk-reduction interventions for this vulnerable population of young women. Sources of Support: CDC, Ferguson Fellowship Program [1U50MN000025], NIMHD [P20MD000198]. 59. GUATEMALA CITY YOUTH: A DESCRIPTIVE STUDY OF HEALTH INDICATORS THROUGH THE LENS OF A CLINICAL REGISTRY Sarah A. Golub, MD 1, Juan Carlos Maza, MD 2, Catherine Stamoulis, PhD 1, Hayley Teich, MD 3, Erwin Humberto Calgua, MD 4, Areej Hassan, MD, MPH, FSAHM 5. 1 Boston Children’s Hospital; 2Hospital San Juan de Dios, Universidad de San Carlos de Guatemala School of Medicine; 3Boston Children’s Hospital, East Boston Neighborhood Health Center; 4Universidad de San Carlos de Guatemala School of Medicine; 5Boston Children’s Hospital, Harvard Medical School.
Purpose: Despite the inclusion of Adolescent health in the UN Secretary General’s Global Strategy for Children’s Health as well as the UN’s Sustainable Development Goals framework, there has been limited data on adolescent health indicators in low and middle income countries. The objectives of our study were to identify a series of risk behaviors, socio-economic measures, and health status of youth in Guatemala. Methods: We conducted a secondary data analysis of the Pan American Health Organization’s (PAHO/WHO) Sistema Informatico del Adolescente (SIA) clinical registry of youth aged 10-24 years in the greater Guatemala City region. Registry items include a series of measures encompassing the following domains: (1) medical history, (2) socio-economic status, (3) risk behaviors, and (4) mental health status, collected during a visit at the Clínica Integral del Adolescente subspecialty clinic. We examined frequencies for a core set of registry items that together provide a macroscale overview of the characteristics of
Poster Symposia / 60 (2017) S21eS38
Conclusions: Prosocial peers and emotional engagement to school were consistently associated with lower odds of behaviors that can undermine healthy development and school success, highlighting the importance of relationships within the school environment for students’ social and behavioral health. In contrast, peer connectedness was positively associated with several risk behaviors. Programs that provide opportunities for diverse adolescents to develop capacities and competencies for meaningful engagement in learning and to experience school as a positive environment are key elements of efforts designed to reduce health and educational disparities. Fostering positive student competencies and school engagement may be promising approaches for promoting school success and well-being among vulnerable students in urban and suburban settings. Sources of Support: Not applicable. 56. TRENDS IN SUBSTANCE USE AMONG MULTIRACIAL ADOLESCENTS: FINDINGS FROM THE NATIONAL SURVEY ON DRUG USE AND HEALTH, 2005-2014 Marvin So, MPH. Emory University School of Medicine.
Purpose: Although the mixed-race population is the fastest growing segment of the U.S. population (Humes, Jones, & Ramirez, 2011), little is known about the substance use behaviors of bi- and multi-racial people, particularly adolescents. Extant research has focused on White and monoracial minority youth (Clark, Doyle, & Clincy, 2013); what does exist suggests that multi-race individuals have substance use prevalence and initiation rates that are intermediate to and distinct from corresponding monoracial counterparts (Clark, Nguyen, & Kropko, 2013). Given the salience of racial/ ethnic self-identification during adolescence, investigation of substance use among the mixed-race group overall and stratified by specific race combinations is warranted. This study examined nationwide substance use among adolescents age 12-17 who indicated a racial/ethnic identity of two or more races. Methods: We used data from the National Survey on Drug Use and Health, a cross-sectional, nationally-representative survey of people aged 12 and above that examines levels and patterns of substance use in the U.S. Using bivariate and multivariate statistics, we estimated the age-, gender-, and race combination-specific prevalence of past month (i.e., current) substance use for several drugs. Prevalence ratios were calculated to determine mixed-race estimates relative to national averages, across time and socioeconomic status. This included use of marijuana, cigarettes, alcohol, and prescription pain relievers for non-medical reasons, as well as overall use. We limited race combination-specific analyses to groups with sufficient sample size: White-Black, White-Asian, and White-American Indian/Alaska Native (all with crosstabulations for Hispanic origin). Results: Overall prevalence of substance use for mixed-race adolescents has been consistently higher than the national average for the past decade. Prevalence for both groups declined from 2005-2014, with prevalence ratios remaining consistent throughout. Current marijuana and alcohol use fluctuated over the decade, with a recent trend below the national average.
Current cigarette and non-medical prescription pain reliever use remained elevated and persist, with prevalence ratios between (PR: 1.3-2.4) over the study period. We observed increasing prevalence ratios for overall substance use and all four specific substances, for males, older adolescents, and low-income subgroups over time. Prevalence ratios for specific race combinations remained consistent over time, but remain high, particularly for White-Black people (PR: 1.6-2.2) and White-American Indian/ Alaska Natives (PR: 2.3-3.8). Conclusions: Although mixed-race individuals constitute a small, heterogeneous subpopulation, clear and persistent disparities in measures of substance use, particularly for cigarettes and prescription pain relievers, among these youth are concerning. Contextualized with what is known about elevated mental health problems in this population (Whaley, et al., 2006), our findings suggest that extant research on racial/ethnic health disparities has hitherto neglected the growing mixed-race adolescent population. Breaking down the “general multiracial group” (Charmaraman, et al., 2014) is an important next step for advancing understanding of the behavioral health needs of specific multiracial groups. We discuss the implications of racial socialization and code-switching for disentangling the relationship between mixed-race identity and substance use, and offer research needed to formulate prevention and treatment programs for this group. Sources of Support: Not applicable. 57. VALIDITY AND RELIABILITY OF ALCOHOL AND MARIJUANA USE SUSCEPTIBILITY AMONG LATINO YOUTH Diego Garcia-Huidobro, MD, PhD 1, Cynthia Davey, MS 1, Maria Veronica Svetaz, MD, MPH, FSAHM 2, MIchele Allen, MD, MPH, FSAHM 1. 1
University of Minnesota; 2Aqui Para Ti, Hennepin County Medical Center.
Purpose: Latino youth experience high substance use rates that for some ages and substances surpass other race/ethnic groups. Preventive interventions are critical to reduce substance use inequities experienced by Latino youth. An important step is to develop sound measures that will identify youth at-risk before engaging in these behaviors. Measures of youth smoking susceptibility have been evaluated for Latino adolescents, however measures to identify Latino teens who are at risk of alcohol and other illicit substance use are needed. This study aims to determine the test-retest reliability and validity of measures to identify alcohol and marijuana use susceptibility of Latino adolescents. Methods: Padres Informados, Jovenes Preparados was a randomized trial of a parenting intervention to prevent tobacco and illicit substance use on Latino adolescents aged 10 to 14. Only participants randomized to the control group (n¼172), and reported complete data at baseline, 4-month, and 10-month follow ups (n¼139, 81%) were included in this study. Youth were asked 3 questions to determine alcohol susceptibility: 1) Do you think you will try to drink alcohol (more than a few sips) soon?, 2) If one of your best friends were to offer you a drink of alcohol would you drink it?, and 3) Do you think you will be having a drink of alcohol one year from now? Youth were classified as susceptible if they answered yes to any of those questions. Similar questions and
Poster Symposia / 60 (2017) S21eS38
scoring system were used to determine marijuana use susceptibility. Kappa coefficient (95% confidence intervals) between baseline and 4-month susceptibility assessments were used to determine test-retest reliability. Prediction of 10-month substance use by baseline substance use susceptibility adjusted by youth age and gender were used to determine scale validity. Results: Participating youth were mostly born in the US, had a mean age of 12 years, and had a similar proportion of boys and girls. Baseline prevalence of alcohol use susceptibility was 18.2% and marijuana use susceptibility 5.7%. 10-month prevalence of alcohol use was 17.4% and marijuana use 3.7%. Kappa coefficients between baseline and 4-month reports were 0.52 (95% CI: 0.35, 0.70) and 0.81 (95% CI: 0.61, 1.00) for alcohol and marijuana susceptibility. Youth susceptible to alcohol use had 7.63 (95% CI: 2.49, 23.3) odds of using alcohol after 10 months compared to non-susceptible youth, and youth susceptible to marijuana had 43.76 (95% CI: 4.84, 395.9) odds of using marijuana after 10 months compared to non-susceptible adolescents. Conclusions: We report reliable and valid measures of alcohol and marijuana use that can be used to evaluate prevention interventions targeting Latino youth. Sources of Support: National Cancer Institute (U54CA153603) and National Research Service Award (NRSA) in Primary Medical Care, US Department of Health and Human Services. 58. SUBSEQUENT SEXUALLY TRANSMITTED INFECTIONS AMONG ADOLESCENT AND YOUNG ADULT WOMEN USING LONG ACTING REVERSIBLE CONTRACEPTIVES Anthony W. Robateau-Colon, BS 1, Kathy Tomaszewski, BSN 2, Harolyn Belcher, MD, MPH, FSAHM 3, Maria Trent, MD, MPH, FSAHM 2. 1
Ponce Health Sciences University; 2Johns Hopkins Medicine; 3 Kennedy Krieger Institute/Johns Hopkins Medicine. Purpose: Long Acting Reversible Contraceptives (LARC) are recommended a first line of contraceptive option in adolescents and young adult women. However, a recent study of US high school students demonstrated that LARC users were significantly less likely to use condoms and more likely to have multiple sex partners, putting LARC users at potentially greater risk for sexually transmitted infections (STI’s). Given the disproportionately high rate of STI’s among African American adolescents in urban centers; efforts to clarify the relationship between LARC use and STI outcomes is critical. The objective of this study is to determine 1) the rates of STI screening and positivity among sexually active urban youth who had a LARC (intrauterine device or implant) placed for contraceptive management and 2) the relationship between their pre-LARC STI history and subsequent STI infections post-LARC placement among those who were tested. Methods: This study utilized a retrospective cohort analysis of programmatic data collected to track referrals, appointments, and visit outcomes for a novel, clinic-based quality improvement program launched in 2011 within an urban academic practice to enhance LARC access and uptake among young women in Baltimore, Maryland. Programmatic data were augmented by review of the electronic medical record (EMR) to document preand post-LARC STI diagnoses (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), and behaviorally acquired human immunodeficiency virus (HIV). Bivariate analyses were conducted to examine the association
S33
between variables of interest (e.g., parity, insurance status, and Pre-and Post-LARC STI’s) using STATA Intercooled version 13 software. Results: Of 136 patients who had 1 year of follow-up, 80 met criteria for inclusion in the analysis by maintaining the LARC for a year (N¼22 excluded) and having STI screening or testing during the 1-year follow-up period (N¼34 additional cases excluded). The mean age of participants was 17.6 (SD¼2.5), 96.2% (n¼77) were African American, 87.5% (n¼70) had public insurance, 7.5% (n¼6) private and 5% (n¼4) uninsured. Thirty percent (n¼24) had a history of STI’s and 15% (n¼12) had a history of pregnancy. The post-LARC rate of STI’s was lower, 21.2% (CT¼ 58.8%, NG¼0% TV ¼X¼41.2%). Of those who did not have a Pre-LARC STI history, 17.9% (n¼10) acquired an STI following LARC. The rate of STI’s among those with a Pre-LARC STI history was 29.2% (n¼7). The difference in the rates of STI’s did not reach statistical significance after adjusting for parity, age of insertion, and insurance. Conclusions: Adolescent girls having LARCs placed in this urban clinical program have high rates of STIs both before and following LARC placement. 30% of those with a LARC in place for a year were not rescreened for STIs. While there was a trend towards higher rates of post-LARC STI among girls with a Pre-LARC STI history, this finding did not reach statistical significance. Close follow-up of LARC users including routine STI screening to follow STI and fertility outcomes is warranted to determine the need for additional risk-reduction interventions for this vulnerable population of young women. Sources of Support: CDC, Ferguson Fellowship Program [1U50MN000025], NIMHD [P20MD000198]. 59. GUATEMALA CITY YOUTH: A DESCRIPTIVE STUDY OF HEALTH INDICATORS THROUGH THE LENS OF A CLINICAL REGISTRY Sarah A. Golub, MD 1, Juan Carlos Maza, MD 2, Catherine Stamoulis, PhD 1, Hayley Teich, MD 3, Erwin Humberto Calgua, MD 4, Areej Hassan, MD, MPH, FSAHM 5. 1 Boston Children’s Hospital; 2Hospital San Juan de Dios, Universidad de San Carlos de Guatemala School of Medicine; 3Boston Children’s Hospital, East Boston Neighborhood Health Center; 4Universidad de San Carlos de Guatemala School of Medicine; 5Boston Children’s Hospital, Harvard Medical School.
Purpose: Despite the inclusion of Adolescent health in the UN Secretary General’s Global Strategy for Children’s Health as well as the UN’s Sustainable Development Goals framework, there has been limited data on adolescent health indicators in low and middle income countries. The objectives of our study were to identify a series of risk behaviors, socio-economic measures, and health status of youth in Guatemala. Methods: We conducted a secondary data analysis of the Pan American Health Organization’s (PAHO/WHO) Sistema Informatico del Adolescente (SIA) clinical registry of youth aged 10-24 years in the greater Guatemala City region. Registry items include a series of measures encompassing the following domains: (1) medical history, (2) socio-economic status, (3) risk behaviors, and (4) mental health status, collected during a visit at the Clínica Integral del Adolescente subspecialty clinic. We examined frequencies for a core set of registry items that together provide a macroscale overview of the characteristics of