MARIJUANA USE ASSOCIATED WITH PSYCHOSOCIAL SYMPTOMS AMONG ADOLESCENTS UTILIZING URBAN SCHOOL-BASED HEALTH CENTERS

• Published in: Journal of adolescent health Vol. 68; no. 2S; p. S40
• Main Authors: Hoffman, Neal D, Ciarleglio, Adam, Corbeil, Tom, Kaur, Harpreet, Sandfort, Theo
• Format: Journal Article
• Language: English
• Published: New York Elsevier BV 01.02.2021
• Subjects: Additives; Adolescents; Age; Alcohol use; At risk populations; Drug abuse; Drug legalization; Drug use; Ethnicity; Females; Gender; Health facilities; HIV; Human immunodeficiency virus; Internalization; Males; Marijuana; Medical screening; Prevention programs; Preventive medicine; Psychosocial factors; Race; Racial differences; Risk factors; Substance abuse; Symptoms; Teenagers; Urban schools
• ISSN: 1054-139X; 1879-1972

Purpose: 20% of in-school U.S. adolescents reported current marijuana use, according to the 2017 YRBS. A recent Canadian population-based study showed that marijuana use was associated with internalizing and externalizing symptoms, with higher risk among females. We analyzed substance use and psychosocial screening among adolescents utilizing services at a network of urban school-based health centers (SBHCs) to determine an association between marijuana use and psychosocial symptomatology. Methods: As part of an implementation study to improve targeted HIV prevention services at a network of SBHCs in the Bronx, New York, adolescents were screened annually at preventive visits with the CRAFFT screener to identify marijuana, alcohol or other drug use in the last 12 months, and with the Y-PSC-17 screener to identify internalizing, attentional or externalizing symptoms. Adolescents self-administered screens at visit arrival; results were entered into the EHR and reviewed by the medical provider with the adolescent face-to-face. We included all medical visits for adolescents at 12 SBHCs from September 2015-March 2020, and analyzed the earliest visit at which an adolescent was screened. Primary analyses comprised fitting logistic and linear (with robust standard errors) models to assess relative and additive associations between marijuana use and Y-PSC-17 outcomes, adjusting for gender, age > 16, race and ethnicity. We also assessed possible modifying effects of gender on the associations between marijuana use and Y-PSC-17 outcomes. Results: Of 19,586 unique patients with at least one medical visit during the study period, 7259 (37%) had CRAFFT screening. The mean age was 16 (SD=1.5), 41% were male, 26% were Black, and 47% were Hispanic. 1381 (19%) of 7083 with complete CRAFFT information reported marijuana use, with more females reporting use (RD = 5.9%; p 16 had lower risk of positive total and attentional scores (p<0.001) on the Y-PSC-17, with no evidence of non-null risk differences for race or ethnicity. Males had lower risk of positive total, internalization, and attentional scores (p<0.001), but not externalization score (p = 0.76). Compared to non-users, marijuana users had a higher odds/risk of positive total (OR=2.28/RD = 8.7%), attentional (OR=2.32/RD - 6.1%), and externalization (OR=2.73/RD = 3.0%) scores, adjusting for age, gender, race and ethnicity (p<0.001). The additive model showed that gender modifies the association between marijuana use and internalization score (p = 0.01) with females having RD = 14.8% (p < 0.001) and males having RD = 7.9% (p < 0.001). While the multiplicative model showed no such modifying effect by gender, it did show an overall positive association between marijuana use and internalization score (OR=1.95, p<0.001). Conclusions: This cross-sectional analysis of CRAFFT and Y-PSC-17 screening in a cohort of adolescents utilizing urban school-based health centers reveals a significant association between marijuana use and psychosocial symptoms, especially internalization, and with greater effect for females. Concurrent screening for substance use and psychosocial symptomatology is crucial to identify at-risk adolescents in need of higher levels of intervention.