title: The significance of marijuana use among alcohol-using adolescent emergency department patients.
abstract: OBJECTIVE
  The objective was to determine if adolescents presenting to a pediatric emergency department (PED) for an alcohol-related event requiring medical care differ in terms of substance use, behavioral and mental health problems, peer relationships, and parental monitoring based on their history of marijuana use.
  
  
  METHODS
  This was a cross-sectional comparison of adolescents 13-17 years old, with evidence of recent alcohol use, presenting to a PED with a self-reported history of marijuana use. Assessment tools included the Adolescent Drinking Inventory, Adolescent Drinking Questionnaire, Young Adult Drinking and Driving Questionnaire, Center for Epidemiologic Studies Depression Scale, Behavioral Assessment System for Children, and Peer Substance Use and Tolerance of Substance Use Scale.
  
  
  RESULTS
  Compared to adolescents using alcohol only (AO), adolescents who use alcohol and marijuana (A+M) have higher rates of smoking (F = 23.62) and binge drinking (F = 11.56), consume more drinks per sitting (F = 9.03), have more externalizing behavior problems (F = 12.53), and report both greater peer tolerance of substance use (F = 12.99) and lower parental monitoring (F = 7.12).
  
  
  CONCLUSIONS
  Adolescents who use A+M report greater substance use and more risk factors for substance abuse than AO-using adolescents. Screening for a history of marijuana use may be important when treating adolescents presenting with an alcohol-related event. A+M co-use may identify a high-risk population, which may have important implications for ED clinicians in the care of these patients, providing parental guidance, and planning follow-up care.
authors.affiliation: Departments of Emergency Medicine and Pediatrics, The Alpert Medical School of Brown University, Providence, RI, USA. Thomas_Chun@brown.edu
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Chun
authors.forename: Anthony
authors.initials: A
authors.lastname: Spirito
authors.forename: Lynn
authors.initials: L
authors.lastname: Hernández
authors.forename: Anne M
authors.initials: AM
authors.lastname: Fairlie
authors.forename: Holly
authors.initials: H
authors.lastname: Sindelar-Manning
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Eaton
authors.forename: William J
authors.initials: WJ
authors.lastname: Lewander
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology*; D000704:Analysis of Variance; D002986:Clinical Trials as Topic; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology* / Q000523:psychology*; D009511:New England / Q000453:epidemiology; D010372:Pediatrics; D011795:Surveys and Questionnaires