Background/Purpose: Adolescence is a unique stage with pubertal maturation, individuation from parents and peer group identification.  The impact of a rheumatic condition can affect social, emotional and sexual development.  We sought to examine the risky behavior of youth with rheumatic conditions, compare it to their unaffected peers, and identify differences between infusion (INF) and non-infusion (OP) patients (pts).

Methods: 50 pts with a rheumatologic diagnosis (RHEUM) from the rheumatology clinic and the ambulatory infusion center at a tertiary children’s hospital were surveyed with the Audio Computer-Assisted Self-Interview (ACASI) system to assess their substance use and sexual health.  Data from the RHEUM pts was compared to the Youth Behavior Surveillance – United States – 2011 (YRBS) for the region, and between INF and OP groups.  The YRBS assesses the prevalence of health-risk behaviors in youth grades 9-12.

Results:

50 pts (42F: 8 M) aged 15-20 yrs were primarily Latino (74%).  Diagnoses included arthritis (15), systemic lupus erythematosus (15), mixed connective tissue disease/ overlap syndrome (MCTD) (8), dermatomyositis (4), vasculitis (3) and unidentified (5).  OP (n=26) and INF (n=24) pts were almost equal.

RHEUM patients reported lower percentage (%) of alcohol use (28% vs 65.1% CI 62.2-67.9%), binge drinking (10% vs 17.9% CI 15.5 – 20.5%), cigarette use (26% vs 39.2% CI 34.8 – 43.7%) and marijuana use (26%42.4% CI 37.0 – 47.9%) when compared to YRBS. INF and OP pts did not differ significantly in alcohol (63% vs 54%, p = 0.40) and marijuana use (25% vs 27%, p = 0.957), but cigarette use was more prevalent in INF than OP (21% vs 31%, p = 0.54). 14% of RHEUM pts gave health reasons for MJ use and 4% of INF pts had a medical MJ card.  12% of RHEUM pts had tried other street drugs (INF-4% vs OP 12% p=0.12).  Prescription drug misuse was similar for RHEUM pts (14%) and YRBS (12.1% CI 10.0 – 14.5%) as well as INF and OP pts (17% and 12%) (p = 0.61). 

RHEUM pts and YRBS had similar rates of first sexual experience (42% vs 38.9% (CI 32.4 – 45.7%), with equal results in INF and OP 42% (p = 0.96).  RHEUM pts had a slightly higher % of current sexual activity than YRBS (28% vs 25.7% CI 20.1 – 32.1%) with higher % in the INF pts than the OP (33% vs 23%) (p = 0.432). 

Of the 14 sexually active RHEUM pts, 57% used condoms, 75% INF vs 33% OP (p = 0.26).  Condom use during last sexual intercourse (SI) was similar between RHEUM pts and YRBS (64.3% vs 61.1% CI 55.2 – 66.7%), with 14% of RHEUM pts using other forms of birth control (BC) during last SI vs 10.9% YRBS (CI 7.2 – 16.2).   

70% of RHEUM pts had future plans for children but only 46% had discussed this with their rheumatologist.   50% felt that their condition or medication could interfere with a pregnancy with higher % in the INF than OP pts (58% vs 42%, p = 0.014).

Conclusion: Adolescents and young adults in a primarily Latino pediatric rheumatology population participate in risky sexual and substance use behaviors at rates similar to their unaffected peers with no statistically significant difference between INF and OP sub-groups. Routine screening and counseling by healthcare providers is important to decrease morbidity.  

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sexual-health-and-substance-abuse-in-adolescents-with-rheumatic-conditions/