CRAFFT Score Research Articles

Improving alcohol and substance use screening in school-age children: translation, adaptation and psychometric evaluation of the CRAFFT tool for Lumasaaba, Uganda

BackgroundChildren at risk of substance use disorders (SUD) should be detected using brief structured tools for early intervention. This study sought to translate and adapt the Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) tool to determine its diagnostic accuracy, and the optimum cut-point to identify substance use disorders (SUD) risk in Ugandan children aged 6 to 13 years.MethodsThis was a sequential mixed-methods study conducted in two phases. In the first qualitative phase, in Kampala and Mbale, the clinician-administered CRAFFT tool version 2.1 was translated into the local Lumasaaba dialect and culturally adapted through focus group discussions (FGDs) and in-depth interviews, in collaboration with the tool’s authors. Expert reviews and translations by bilingual experts provided insights on linguistic comprehensibility and cultural appropriateness, while pilot testing with the target population evaluated the tool’s preliminary effectiveness. In the second phase, the CRAFFT tool, adapted to Lumasaaba, was quantitatively validated against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) for diagnosing SUD in Mbale district, through a survey. Participants, chosen randomly from schools stratified according to ownership, location, and school size, were assessed for the tool’s reliability and validity, including comparisons to the MINI KID as the Gold Standard for diagnosing SUD. Data were analyzed using STATA-15. Receiver-operating-characteristic analysis was performed to determine the sensitivity, specificity, and criterion validity of the CRAFFT with the MINI-KID.ResultsOf the 470 children enrolled, 2.1% (n = 10) had missing data on key variables, leaving 460 for analysis. The median age and interquartile range (IQR) was 11 (9–12) years and 56.6% were girls. A total of 116 (25.2%) children had consumed alcohol in the last twelve-month period and 7 (1.5%) had used other substances. The mean CRAFFT score for all the children (n = 460) was 0.32 (SD 0.95). The prevalence of any alcohol use disorder (2 or more positive answers on the MINI KID) in the last 12 months was 7.2% (n = 32). The Lumasaaba version of the CRAFFT tool demonstrated good internal consistency (Cronbach’s α = 0.86) and inter-item correlation (Spearman correlation coefficient of 0.84 (p < 0.001). At a cut-off score of 1.00, the CRAFFT had optimal sensitivity (91%) and specificity (92%) (Area Under the Curve (AUC) 0.91; 95% CI 0.86–0.97) to screen for SUD. A total of 62 (13.5%) had CRAFFT scores of > 1.ConclusionThe Lumasaaba version of the CRAFFT tool has sufficient sensitivity and specificity to identify school-age children at risk of SUD.

Problematic substance use in depressed adolescents: Prevalence and clinical correlates

BackgroundSubstance use among adolescents is common and associated with significant consequences, including depression. Adolescents can experience myriad problems related to early onset substance use and depression, making further understanding of this comorbidity necessary. MethodParticipants were a subset from a large-scale performance improvement project and consisted of adolescents aged 12–18 who screened positive for depression during their routine medical or psychiatric appointment and who then completed the substance use assessment Car, Relax, Alone, Forget, Friends, Trouble Version 2.1 (CRAFFT). Participants with problematic substance use had a CRAFFT score ≥2. ResultsA total of 621 participants were included in this study, and 105 (16.9%) reported problematic substance use. Compared with participants without problematic substance use, those with problematic use were more likely to have moderate to severe depression and anxiety, as well as significantly higher irritability, impulsivity, suicidal propensity, and suicidal thoughts scores. Controlling for age at screening, sex, race, and ethnicity, problematic substance use remained a significant predictor of depression severity, impulsivity, suicidal propensity, and suicidal thoughts. LimitationsParticipants were from a large, metropolitan area of the Southwest United States who must have screened positive for depression, so results may not generalize. Because all participants were underage, they may have been wary in responding to the substance use assessment accurately. ConclusionsBy using a large, diverse sample in a real-world clinical setting, findings strengthen the association between problematic substance use and depression and depression-associated symptoms among adolescents, highlighting the need for early detection and universal depression screening.

160 Trends of Reported Marijuana Use in a Pediatric Emergency Department

Thirty-three states have legalized recreational and/or medicinal marijuana, leading to normalization of its use, and desensitization of perceived risk. We utilized electronic health record data from a Pediatric ED located in a state which has legalized medicinal marijuana, and examined the changes in reported marijuana use among adolescents, and the relationship between marijuana use, use of other drugs, and risk for substance use disorder (SUD). We implemented a team-based adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) program in a Pediatric ED in January 2018, utilizing the CRAFFT tool to screen patients ages 12-17. Individual CRAFFT responses were examined for the 8,694 of 24,057 (36.1%) patients screened from January 2018 to October 2019. Pearson chi-square tests were used to compare use of reported substances from 2018 to 2019 to identify trends in the use of each substance (alcohol, marijuana, and other drugs). Binary logistic regression was used to examine the predictors of both a positive CRAFFT score (2 or higher in Part B, validated for identifying an SUD) and other drug use. Reported alcohol use decreased from 2018 to 2019, from 8.5% to 7.3% (p=0.04), marijuana use increased from 9.1% to 11.3% (p=0.09), and other drug use did not change (1.9%). 39.2% of those reporting substance use reported using only marijuana. Those reporting alcohol use had 4.9 (95% CI 3.3-7.2) times the odds of other drug use, and those reporting marijuana use had 14.5 (95% CI 9.4-22.4) times the odds, adjusting for age and sex. Among the 1,066 patients with a “Yes” in Part A for whom Part B was completed, those reporting other drug use, marijuana use, and alcohol use had 8.7 (95% CI 5.7-13.4), 5.4 (95% CI 3.5-8.2) and 1.5 (1.1-2.0) times the odds of a positive score, respectively, adjusting for age and sex. Marijuana use is the most prevalent form of reported substance use among adolescents in the ED and is increasing. Marijuana was a stronger predictor than alcohol of a positive CRAFFT, which has an 80% sensitivity and 86% specificity for a SUD. There is an association between reported use of marijuana and reported use of other drugs. Given the increase in social acceptance of marijuana use, and its association with additional drug use, it is critical for health care professionals to identify and address marijuana use with adolescent patients. One limitation of this study is that the version of the CRAFFT programmed into the EHR does not specifically ask about vaping, and therefore may not be capturing all patients who vape THC. Future directions include changing the CRAFFT embedded in the EHR to the CRAFFT 2.1+N, which specifically asks about vaping both marijuana/THC and nicotine. This will allow us to better identify and address the increasing marijuana use in our adolescent population.

Adolescent SBIRT implementation: Generalist vs. Specialist models of service delivery in primary care

BackgroundDrug, alcohol, and tobacco use among adolescents pose significant short- and long-term health consequences and are associated with more severe use as adults. Screening, brief intervention, and referral to treatment in primary care settings has the potential to deliver preventive interventions to a diverse range of adolescents, but optimal implementation of these services needs to be determined. The purpose of this study was to compare implementation of two different SBIRT service delivery models in primary care settings. MethodsThis cluster-randomized trial assigned 7 primary care clinics of a federally qualified health center to implement brief interventions (BI) using a Generalist model (4 sites), in which BIs were delivered by the primary care provider (PCP), or a Specialist model (3 sites), in which BIs were delivered by a behavioral health counselor (BHC) for adolescent patients ages 12–17 years. Implementation was tracked through the clinic's electronic health record, spanning 9639 clinic visits over 20 months. Multilevel logistic regression modeling was used to compare Generalist and Specialist strategies on penetration of BI for patients scoring ≥2 on the CRAFFT substance use screen, delivered by the PCP in the Generalist sites, and via warm hand-off to a BHC in the Specialist sites. ResultsApproximately 62% of adolescent patient visits were screened with the CRAFFT (with <4% screening positive with a CRAFFT score ≥ 2). The Generalist Condition had significantly higher self-reported penetration of BI delivery than the Specialist Condition (38% vs. 8%; Adjusted Odds Ratio = 6.53; p = .005). DiscussionDespite having co-located behavioral health services at all sites, a Specialist approach to providing BI was less effectively implemented than a Generalist approach in this FQHC. BI delivered by PCPs rather than by hand-off to a BHC may ensure greater penetration of these services in primary care settings. Both implementation models provided a framework for identifying and intervening with adolescent primary care patients whose substance use might have otherwise gone undetected.

Sleep quality and its association with substance abuse among university students

ObjectivePoor sleep is one of the greatest health problems with social significance whose prevalence started early in adolescence. The relationship between poor sleep quality and the use of alcohol and illicit substances among university students has not been studied. Our study aimed to determine these relationships and the factors influencing the risk of poor sleep in students from health sciences degrees which are the future healthcare providers. Patients and methodsA cross-sectional study performed in European university students (n = 676). Sleep quality was assessed by measuring insomnia symptoms with the Athens insomnia scale (AIS). The CRAFFT screening test and AUDIT test were used to measure the use of substances of abuse. ResultsInsomnia symptoms were highly prevalent (40.2%) and more common among the youngest students (p = 0.012), who had been studying at the university for less time (p = 0.018), and had high levels of illicit drug use (p = 0.037). Good sleep quality represented a significant protective factor for problematic drug use, with an OR of 0.8 (CI95%: 0.76-0.99). In contrast, the category “not having a job” represents risk 1.2 times higher (CI95%: 1.025–1.557) for problematic drug use. The CRAFFT score significantly predicted higher insomnia symptoms (AIS ≥ 6), yielding an OR of 1.2 (CI95%:1.10-1.32, p < 0.001). ConclusionsPoor sleep quality is common in university students. There is an inverse association between higher insomnia symptoms and illicit drug abuse being a good sleep qualitya protective factor against problematic use of illicit drugs. Several personal and social consequences of illicit drug use are related to poor sleep in this population and it deserves future studies and interventions in order to improve both problems.

Predicting Adolescent Substance Use in a Child Welfare Sample: A Multi-Indicator Algorithm

Given the risk of substance use (SU) among adolescents in the child welfare system, identification of risk for prospective impairing SU behaviors is a significant public health priority. We sought to quantify the incremental validity of routine multi-informant assessments of adolescent psychological distress (i.e., the Child Behavior Checklist and Youth Self-Report) and a commonly used SU screening protocol (i.e., the CRAFFT) to predict SU at 18 and 36 months after baseline in a nationally representative child welfare sample (N = 1,054; Mage = 13.72). We used receiver operator characteristics and reclassification analyses to develop our algorithms. We found that a battery consisting of baseline CRAFFT scores, self-reported delinquent behavior, and parent-reported rule-breaking behavior provided an incrementally valid prediction model for SU behavior among females, while baseline CRAFFT scores and self-reported delinquent behavior incrementally predicted SU for males. Results suggest that leveraging existing assessments within the child welfare system can improve forecasting of SU risk for this population.

페루 도시빈곤지역 청소년의 문제음주행동에 대한 학교 건강증진 프로그램의 효과

Objectives: The purpose of this study was to analyze the relationship between a school health promotion program and problem drinking behaviors. Methods: The participants in this study were 1st-5th grade students in secondary school in Lima and Callao, Peru. We conducted pre- and post-surveys in 2014 and 2017, respectively, to assess the effect of a school health promotion intervention. The school health promotion intervention was implemented from 2015 to 2017 in four schools, and two schools were taken as control groups in collaboration with the Korea International Cooperation Agency. Randomized stratified sampling was performed to analyze 971 participants in the experimental group and 585 in the control group. The homogeneity test was conducted before the intervention. A chi-square test and logistic regression analysis were performed. The participants in this study were 1 to 5 grade students in secondary school in Lima and Callao, Peru. We conducted a pre-intervention survey in 2014 and post-intervention survey in 2017 to assess the effect of a school health promotion intervention. The school health intervention was implemented from 2015 to 2017 in 4 schools, and two schools were taken as control groups in collaboration with Korea International Cooperation Agency (KOICA). A randomized stratified sampling was performed to analyze 971 subjects in the experimental group and 585 subjects in the control group. The homogeneity test was conducted before the intervention. Chi-square test and logistic regression analysis was performed. Results: First, 35.7% of the students had experienced drinking more than once in their lifetime and 59.2% had experienced drinking in the last year. Among the 556 students who had experienced drinking, 21.9% had CRAFFT scores of 2 or more for problem drinking. Second, there were differences in general and problem drinking based on “gender,” “academic performance,” “part-time job,” “depression,” “smoking,” “drugs,” “sexual experience,” “school truancy,” and “violence or harassment from school friends.” Third, the proportion of problem drinkers was 15.2% in the experimental group and 32.1% in the control group; problem drinking was significantly higher in the control group. Finally, the risk of problem drinking in the control group was significantly increased by about 2.8 times as compared with the group receiving the intervention through the school health promotion program. Conclusion: The school health promotion program had a statistically significant effect on the improvement of adolescent drinking behaviors. Schools should strengthen health promotion and education to stimulate comprehensive activities to prevent drinking, smoking, and other substance abuse among adolescents.

Stimulant Use Among Undergraduate Nursing Students.

Research reveals a decade-long increase in prescription drug misuse (PDM) of stimulant medication used to treat attention deficit hyperactivity disorder, and college students in particular are at the highest risk for these behaviors. However, PDM has not been specifically studied in undergraduate nursing students, and thus, this study fills a gap in our knowledge of PDM of stimulants. This descriptive study used a cross-sectional, convenience sample of undergraduate nursing students (N = 249) attending a large midwestern university. The purpose of this study was to examine the medical use, medical misuse, nonmedical use, and diversion of attention deficit hyperactivity disorder stimulant medications as well as to compare CRAFFT scores among these four groups of stimulant users. A 28-item, Web-based survey was sent via email to all registered undergraduate nursing students during the winter semester of 2017. Results showed that 10.4% of respondents used prescription stimulants nonmedically in the past 12 months, and over half (51.5%) of respondents screened positive on the CRAFFT, an indication of possible alcohol and drug misuse behaviors. In addition, there was a strong association between medical misuse and nonmedical use and positive CRAFFT scores. The high percentage of positive CRAFFT scores is a concern and indicates a pressing need for nursing faculty to evaluate and address substance use by nursing students.

Associations Between Maltreatment History and Severity of Substance Use Behavior in Youth in Foster Care.

Substance use (SU) in youth remains a significant public health concern and a risk factor for morbidity and mortality in adolescents. The present study offers examination of the association between severity and chronicity of maltreatment history and SU in youth in foster care. Two hundred and ten (48% female) foster youth with a mean age of 12.71 years ( SD = 2.95 years) completed surveys using an audio-computer-assisted self-interview program. Results revealed 31% of participants reported past-year SU, and substance users had a mean CRAFFT score of 3.43 ( SD = 1.90). Reported age of SU onset was 11.08 years ( SD = 2.21 years). The SU measurement model demonstrated excellent fit in this sample. Accounting for both youth age and youth placement type, the structural model with maltreatment predicting SU severity demonstrated strong model fit with a significant path between maltreatment and SU. Youth in residential facilities and older youth had higher rates of use than those residing in traditional foster home environments and younger youth. Findings provide additional support for the link between maltreatment experiences and SU severity in foster youth and suggest the need for screening and intervention services appropriate for this high-risk population.

Usefulness of the CRAFFT to Diagnose Alcohol or Cannabis Use Disorders in a Sample of Emerging Adults with Past-Month Alcohol or Cannabis Use

ABSTRACTBackground: Emerging adults between the ages of 18 and 25 have the highest rates of illicit drug use and heavy alcohol use. The purpose of this study was to determine the performance of the Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) screening to identify alcohol and cannabis use disorders using Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria in a sample of emerging adults who use alcohol or cannabis or both. Methods: Study participants were recruited as part of a larger intervention study of health behaviors among emerging adults between the ages of 18 and 25 reporting alcohol and/or cannabis use. As part of baseline data collection, responses to the CRAFFT (score range: 0–6) and the Structured Clinical Interview for DSM-IV (SCID) were recorded. Additional questions about craving permitted approximation with DSM-5 diagnoses of alcohol and cannabis use disorders. Results: Participants (N = 382) averaged 21 (±2.1) years of age, 47% were male, 65% were non-Latino Caucasian, and using the SCID 42% met criteria for an alcohol use disorder and 45% met criteria for cannabis use disorder. When evaluating for any alcohol use disorder alone, using a cutoff score of 4, the sensitivity was 81.4% but the specificity was only 45.3%. At a cutoff score of 4, sensitivity for identifying any cannabis use disorder alone was 83.7% and specificity was 48.6%. Conclusions: In emerging adults who report using alcohol or cannabis, the CRAFFT had low specificity for predicting alcohol or cannabis use disorder, despite using higher cut scores than previously published. The CRAFFT's utility in determining clinical substance use disorders in this population may be limited.

Uso indevido de drogas e função sexual em adolescentes com doenças crônicas

ObjectiveTo evaluate alcohol/tobacco and/or illicit drug misuse in Chronic Diseases (CDs). MethodsA cross‐sectional study with 220 CDs adolescents and 110 healthy controls including: demographic/anthropometric data; puberty markers; modified questionnaire evaluating sexual function, alcohol/smoking/illicit drug misuse and bullying; and the physician‐conducted CRAFFT (car/relax/alone/forget/friends/trouble) screen tool for substance abuse/dependence high risk. ResultsThe frequencies of alcohol/tobacco and/or illicit drug use were similar in both groups (30% vs. 34%, p=0.529), likewise the frequencies of bullying (42% vs. 41%, p=0.905). Further analysis solely in CDs patients that used alcohol/tobacco/illicit drug versus those that did not use showed that the median current age [15 (11–18) vs. 14 (10–18) years, p<0.0001] and education years [9 (5–14) vs. 8 (3–12) years, p<0.0001] were significant higher in substance use group. The frequencies of Tanner 5 (p<0.0001), menarche (p<0.0001) and spermarche (p=0.001) were also significantly higher in patients with CDs that used alcohol/tobacco/illicit, likewise sexual activity (23% vs. 3%, p<0.0001). A trend of a low frequency of drug therapy was observed in patients that used substances (70% vs. 82%, p=0.051). A positive correlation was observed between CRAFFT score and current age in CD patients (p=0.005, r=+0.189) and controls (p=0.018, r=+0.226). ConclusionsA later age was evidenced in CDs patients that reported licit/ilicit drug misuse. In CDs adolescent, substance use was more likely to have sexual intercourse. Our study reinforces that these patients should be systematically screened by pediatricians for drug related health behavioral patterns.

Substance use and sexual function in juvenile idiopathic arthritis

ObjectiveTo evaluate alcohol/tobacco/illicit drug use and sexual function in adolescent juvenile idiopathic arthritis (JIA) and healthy controls. Methods174 adolescents with pediatric rheumatic diseases were selected. A cross-sectional study with 54 JIA patients and 35 controls included demographic/anthropometric data and puberty markers assessments, physician-conducted CRAFFT (car/relax/alone/forget/friends/trouble) screen tool for substance abuse/dependence high risk and a questionnaire that evaluated sexual function, bullying and alcohol/tobacco/illicit drug use. Clinical/laboratorial data and treatment were also assessed in JIA. ResultsThe median current age was similar between JIA patients and controls [15(10–19) vs. 15(12–18) years, p=0.506]. Frequencies of alcohol/tobacco/illicit drug use were high and similar in both JIA and controls (43% vs. 46%, p=0.829). However, age at alcohol onset was significantly higher in those with JIA [15(11–18) vs. 14(7–18) years, p=0.032], particularly in polyarticular onset (p=0.040). High risk for substance abuse/dependence (CRAFFT score≥2) was found in both groups (13% vs. 15%, p=1.000), likewise bullying (p=0.088). Further analysis of JIA patients regarding alcohol/tobacco/illicit drug use showed that the median current age [17(14–19) vs. 13(10–19)years, p<0.001] and education years [11(6–13) vs. 7(3–12)years, p<0.001] were significant higher in those that used substances. Sexual activity was significantly higher in the former group (48% vs. 7%, p<0.001). A positive correlation was evidenced between CRAFFT score and current age in JIA patients (p=0.032, r=+0.296). ConclusionA high risk for substance abuse/dependence was observed in both JIA and controls. JIA substance users were more likely to have sexual intercourse. Therefore, routine screening is suggested in all visits of JIA adolescents.

Alcohol, smoking and illicit drug use in pediatric systemic lupus erythematosus patients

ObjectiveTo evaluate alcohol, smoking and/or illicit drug use, and history of bullying in adolescent childhood-onset systemic lupus erythematosus and healthy controls. Methods174 adolescents with pediatric rheumatic diseases were selected. All of the 34 childhood-onset systemic lupus erythematosus patients and 35 healthy controls participated in this study. A cross-sectional study included demographic/anthropometric data and puberty markers assessments; structured questionnaire and CRAFFT screening interview. ResultsMcNemar tests indicated an excellent test–retest reliability of the structured questionnaire (p=1.0). The median current age was similar between childhood-onset systemic lupus erythematosus patients and controls [15 (12–18) vs. 15 (12–18) years, p=0.563]. The median of menarche age was significantly higher in childhood-onset systemic lupus erythematosus patients compared to controls [12 (10–15) vs. 11.5 (9–15) years, p=0.041], particularly in those that lupus had occurred before first menstruation [13 (12–15) vs. 11.5(9–15) years, p=0.007]. The other puberty marker and sexual function parameters were similar in both groups (p>0.05). Alcohol use was similar in both childhood-onset systemic lupus erythematosus patients and controls (38% vs. 46%, p=0.628). A trend of lower frequency of CRAFFT score ≥2 (high risk for substance abuse/dependence) was evidenced in childhood-onset systemic lupus erythematosus patients compared to controls (0% vs. 15%, p=0.053). Bullying was reported similarly for the two groups (43% vs. 44%, p=0.950). Further analysis in lupus patients regarding alcohol/smoking/illicit drug use showed no differences in demographic data, puberty markers, history of bullying, sexual function, contraceptive use, disease activity/damage scores, clinical/laboratorial features and treatments (p>0.05). ConclusionThis study showed high frequencies of early alcohol use in lupus adolescents and healthy controls, despite of a possible low risk for substance abuse/dependence in childhood-onset systemic lupus erythematosus patients.

Uso de substâncias e função sexual na artrite idiopática juvenil

Objectiveto evaluate alcohol/tobacco/illicit drug use and sexual function in adolescent juvenile idiopathic arthritis (JIA) and healthy controls. Methods174 adolescents with pediatric rheumatic diseases were selected. A cross‐sectional study with 54 JIA patients and 35 controls included demographic/anthropometric data and puberty markers assessments, physician‐conducted CRAFFT (car/relax/alone/forget/friends/trouble) screen tool for substance abuse/dependence high risk and a questionnaire that evaluated sexual function, bullying and alcohol/tobacco/illicit drug use. Clinical/laboratorial data and treatment were also assessed in JIA. ResultsThe median current age was similar between JIA patients and controls [15(10‐19) vs. 15(12‐18)years, p=0.506]. Frequencies of alcohol/tobacco/illicit drug use were high and similar in both JIA and controls (43% vs. 46%, p=0.829). However, age at alcohol onset was significantly higher in those with JIA [15(11‐18) vs. 14(7‐18)years, p=0.032], particularly in poliarticular onset (p=0.040). High risk for substance abuse/dependence (CRAFFT score≥2) was found in both groups (13% vs. 15%, p=1.000), likewise bullying (p=0.088). Further analysis of JIA patients regarding alcohol/tobacco/illicit drug use showed that the median current age [17(14‐19) vs. 13(10‐19)years, p<0.001] and education years [11(6‐13) vs. 7(3‐12)years, p<0.001] were significant higher in those that used substances. Sexual activity was significantly higher in the former group (48% vs. 7%, p<0.001). A positive correlation was evidenced between CRAFFT score and current age in JIA patients (p=0.032, r=+0.296). ConclusionA high risk for substance abuse/dependence was observed in both JIA and controls. JIA substance users were more likely to have sexual intercourse. Therefore, routine screening is suggested in all visits of JIA adolescents.

Uso de álcool, tabaco e drogas ilícitas por pacientes com lúpus eritematoso sistêmico pediátrico

Objectiveto evaluate alcohol, smoking and/or illicit drug use, and history of bullying in adolescent childhood‐onset systemic lupus erythematosus (c‐SLE) and healthy controls. Methods174 adolescents with pediatric rheumatic diseases were selected. All of the 34 c‐SLE patients and 35 healthy controls participated in this study. A cross‐sectional study included demographic/anthropometric data and puberty markers assessments; structured questionnaire and CRAFFT screening interview. ResultsMcNemar tests indicated an excellent test‐retest reliability of the structured questionnaire (p=1.0). The median current age was similar between c‐SLE patients and controls [15 (12‐18) vs. 15(12‐18) years, p=0.563]. The median of menarche age was significantly higher in c‐SLE patients compared to controls [12 (10‐15) vs. 11.5 (9‐15) years, p=0.041], particularly in those that lupus had occurred before first menstruation [13 (12‐15) vs. 11.5 (9‐15) years, p=0.007]. The other puberty marker and sexual function parameters were similar in both groups (p>0.05). Alcohol use was similar in both c‐SLE patients and controls (38% vs. 46%, p=0.628). A trend of lower frequency of Crafft score ≥ 2 (high risk for substance abuse/dependence) was evidenced in c‐SLE patients compared to controls (0% vs. 15%, p=0.053). Bullying was reported similarly for the two groups (43% vs. 44%, p=0.950). Further analysis in lupus patients regarding alcohol/smoking/illicit drug use showed no differences in demographic data, puberty markers, history of bullying, sexual function, contraceptive use, disease activity/damage scores, clinical/laboratorial features and treatments (p>0.05). ConclusionThis study showed high frequencies of early alcohol use in lupus adolescents and healthy controls, despite of a possible low risk for substance abuse/dependence in c‐SLE patients.

Substance misuse and sexual function in adolescents with chronic diseases

ObjectiveTo evaluate alcohol/tobacco and/or illicit drug misuse in Chronic Diseases (CDs). MethodsA cross-sectional study with 220 CDs adolescents and 110 healthy controls including: demographic/anthropometric data; puberty markers; modified questionnaire evaluating sexual function, alcohol/smoking/illicit drug misuse and bullying; and the physician-conducted CRAFFT (car/relax/alone/forget/friends/trouble) screen tool for substance abuse/dependence high risk. ResultsThe frequencies of alcohol/tobacco and/or illicit drug use were similar in both groups (30% vs. 34%, p=0.529), likewise the frequencies of bullying (42% vs. 41%, p=0.905). Further analysis solely in CDs patients that used alcohol/tobacco/illicit drug versus those that did not use showed that the median current age [15 (11–18) vs. 14 (10–18) years, p<0.0001] and education years [9 (5–14) vs. 8 (3–12) years, p<0.0001] were significant higher in substance use group. The frequencies of Tanner 5 (p<0.0001), menarche (p<0.0001) and spermarche (p=0.001) were also significantly higher in patients with CDs that used alcohol/tobacco/illicit, likewise sexual activity (23% vs. 3%, p<0.0001). A trend of a low frequency of drug therapy was observed in patients that used substances (70% vs. 82%, p=0.051). A positive correlation was observed between CRAFFT score and current age in CD patients (p=0.005, r=+0.189) and controls (p=0.018, r=+0.226). ConclusionsA later age was evidenced in CDs patients that reported licit/ilicit drug misuse. In CDs adolescent, substance use was more likely to have sexual intercourse. Our study reinforces that these patients should be systematically screened by pediatricians for drug related health behavioral patterns.

CRAFFT as a Substance Use Screening Instrument for Adolescent Psychiatry Admissions.

Adolescent use of alcohol and illicit substances is quite common among pediatric psychiatry inpatients; however, little data exist on substance use screening instruments that can be used to augment thorough psychiatric diagnostic interviews. CRAFFT is a screening tool for adolescent substance use that has been validated in outpatient general medical settings. This is the first study to examine its use in adolescent psychiatric inpatients. We performed a chart review of records from adolescents admitted to our inpatient psychiatric unit who completed a CRAFFT screen on admission. We compared CRAFFT scores with other measures of substance use, including urine drug screens and the diagnosis of a substance use disorder at discharge. We also examined measures of depression and suicidality in individuals with elevated CRAFFT scores (≥2 positive answers out of 6) and compared them with measures in those with normal CRAFFT scores. Elevated CRAFFT scores were correlated with other measures of alcohol and substance use, including the diagnosis of a substance use disorder at discharge (P<0.0001), and laboratory screening for alcohol (P=0.0048) and marijuana (P<0.0001) on admission. Previous suicide attempts (P=0.005) and "psychiatric trauma" (P=0.0027) were also positively associated with elevated CRAFFT scores. CRAFFT scores in adolescent inpatients were correlated with other measures of substance use, supporting its efficacy as a screening tool in this population. CRAFFT scores were also positively correlated with a history of psychiatric trauma and past suicide attempts, which is consistent with the results of previous studies associating pediatric substance use and traumatic life events with an increased risk of suicide.

Role of personal and family factors in alcohol and substance use among adolescents: an international study with focus on developing countries

Most studies examining adolescent alcohol and substance use or abuse hardly include samples from developing countries. To bridge some gap, the prevalence and associated social correlates of alcohol and substance use and abuse was examined among a cohort of school-going adolescents sampled from seven developing countries. Alcohol and substance abuse was measured using the CRAFFT instrument, independent socio-demographic correlates were determined using regression models. A total of 2454 adolescents completed the study, among which 40.9% reported using either alcohol or at least one other substance during the previous 12 months. This was mostly alcohol (37.8%), followed by marijuana/hashish (8.6%) and other substances (8.1%). Among the adolescents who reported using at least one substance, 45% (18.3% of total sample) had CRAFFT scores indicative of problematic or hazardous substance use. Several personal and family factors were independently associated with use/abuse, and the modifiable nature of these factors calls for appropriate intervention strategies.

Beyond prevalence and pattern: problematic extent of alcohol and substance use among adolescents in Ibadan South-west Nigeria

Previous research on adolescent alcohol/substance use in Nigeria had focused on the pattern of use without consideration for the extent of use. Socio-demographic correlates have also not been well explored. Information about socio-demographic correlates can also inform target-points in preventive strategies. Knowledge of the prevalence of problematic pattern of alcohol/substance use can inform the inclusion of rehabilitation strategies in intervention policies. To determine the prevalence, pattern and extent-as well as socio-demographic correlates-of alcohol/substance use among a cohort of adolescents in Nigeria. Pattern and extent of alcohol/substance use was examined using the CRAFFT instrument. A total of 538 adolescents with a mean age of 15.1 ± 1.4 years returned completed questionnaires. 12-month prevalence of alcohol and other substance use was 21.4%. About 46% of those who reported use of alcohol or any other substance had a CRAFFT score of >2 which suggests problematic pattern of use. Older age, male gender, parental alcohol and substance and lower than average school performance were independently associated with 12-moNth use of alcohol or any other substance. Adolescent alcohol and substance use is common in Nigeria and a large proportion of users show a problematic pattern of use that warrants rehabilitative intervention.

Surveying Teens in School to Assess the Prevalence of Problematic Drug Use

Illicit drug use by school-aged teens can adversely affect their health and academic achievement. This study used a survey administered in schools to assess the prevalence of problematic drug use among teenagers in a Midwestern community. Self-report data were collected from 11th- and 12th-grade students (N = 3974) in 16 school districts in the Dayton, Ohio, area. Students responded to a drug use survey that also included CRAFFT, a brief substance abuse screening instrument. Binomial and zero-inflated Poisson regressions were used to examine the association between CRAFFT scores and drug use practices, including abstinence. More than one third of students had CRAFFT scores suggestive of problematic use. Of these, 14.1% had scores suggesting drug dependence. Although alcohol, marijuana, and tobacco were the drugs most commonly used, an array of other drugs including opioids, benzodiazepines, stimulants, hallucinogens, and dextromethorphan were also commonly used. Higher CRAFFT scores were associated with a greater number of drugs used (p < .0001). Proportionately more 12th graders than 11th graders had CRAFFT scores indicating problems (p < .0001). Among 12th graders, boys were more likely than girls to have CRAFFT scores indicating dependence (p = .01). The results suggest that problematic drug use among high school students is more prevalent than has been recognized previously. CRAFFT can be used easily to assess the prevalence of problematic drug use among teenagers in school settings. CRAFFT results can also inform prevention and intervention activities, particularly if the CRAFFT instrument is paired with a drug use survey.