Prevalence of and risk factors for substance use among perinatally human immunodeficiency virus-infected and perinatally exposed but uninfected youth.
OBJECTIVE
This study examined risk factors associated with recent substance use (SU) among perinatally human immunodeficiency virus (HIV)-infected (PHIV+) and perinatally exposed, uninfected (PHEU) youth and compared SU lifetime prevalence with the general population of United States (U.S.) adolescents.


METHODS
We conducted cross-sectional and longitudinal analyses of 511 PHIV+ and PHEU youth (mean age at study entry, 13.2 years; 51% female; 69% PHIV+; and 72% African-American) enrolled in a U.S. multisite prospective cohort study between 2007 and 2009. Substance use data were collected by audio computer-assisted self-interview. Youth Risk Behavior Surveillance System and Monitoring the Future data were used to compare SU lifetime prevalence with U.S. samples.


RESULTS
Perinatal HIV infection was not a statistically significant risk factor for alcohol or marijuana use. Risk factors for alcohol use among PHIV+ youth included higher severity of emotional and conduct problems and alcohol and marijuana use in the home by the caregiver or others. Risk factors for marijuana use among PHIV+ youth included marijuana use in the home, higher severity of conduct problems, and stressful life events. Similar SU risk factors among PHEU youth included SU in the home and higher severity of conduct and emotional problems. Overall lifetime prevalence of SU by age was similar to that in national surveys.


CONCLUSIONS
Although SU lifetime prevalence and risk factors for PHIV+ and PHEU adolescents were similar to national norms, the negative consequences are potentially greater for PHIV+ youth. Prevention efforts should begin before SU initiation and address the family and social environment and youth mental health status.
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Electronic address: jalperen@sdac.harvard.edu.
Julie
J
Alperen
Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts.
Sean
S
Brummel
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
Katherine
K
Tassiopoulos
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York.
Claude A
CA
Mellins
Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts.
Deborah
D
Kacanek
Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois.
Renee
R
Smith
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
George R
GR
Seage
Department of Pediatrics, University of California-San Francisco, San Francisco, California.
Anna-Barbara
AB
Moscicki
D000293:Adolescent; D000294:Adolescent Behavior; D000428:Alcohol Drinking / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008137:Longitudinal Studies; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
Adolescent risk behavior; Adolescents; Human immunodeficiency virus; Perinatal human immunodeficiency virus exposure; Substance use