185. Psychosocial Predictors of Alcohol and Substance Use in College Youth with Type 1 Diabetes


      Adolescents and young adults (AYA) with chronic diseases face unique challenges during the college years and may consume alcohol and other substances as a mechanism for coping with stressors. In this study, we aimed to assess the prevalence of alcohol and other substance use and to determine psychosocial predictors of these behaviors among college youth with type 1 diabetes (T1D).


      College youth with T1D were recruited via social media and direct outreach into a multi-national, web-based study. Participants answered validated questions about alcohol and other substance use, and they completed validated measures of depression and anxiety (PHQ-2 and GAD-2), illness acceptance (ICQ), interpersonal support (ISEL), and resilience (GRIT). Descriptive statistics and multivariable regression were used to evaluate alcohol and substance use behaviors as a function of psychosocial factors while adjusting for age and sex.


      Participants (N=138) attended 85 universities across 30 US states and Canada; the average age was 20.5 years old (SD=1.5), 80.4% were female, and 82.6% were white non-Hispanic. Participants scored an average of 1.36 ± 1.54 and 2.22 ± 1.79 on scales assessing depression and anxiety, respectively; higher scores indicated greater symptoms. They demonstrated moderate illness acceptance (33.66 ± 8.31), interpersonal support (13.44 ± 3.26), and resilience (2.94 ± 0.62), with higher scores indicating greater values. The majority (84.1%) endorsed lifetime alcohol use, while 31.2% had binged alcohol over the past 2 weeks, 21.7% had ever used tobacco cigarettes/cigars, 15.9% had ever used electronic cigarettes, and 41.3% had ever used marijuana. Among all participants, there was an average of 3.85 ± 4.44 days of alcohol use over the past month and 0.60 ± 1.09 binging episodes over the past 2 weeks. In bivariate analyses, higher depression scores were positively associated with lifetime cigarette/cigar use (p=0.02) and marijuana use (p=0.03) and marginally associated with past two-week binge drinking (p=0.06), while higher anxiety scores were marginally associated with lifetime alcohol use (p=0.08). Greater illness acceptance was negatively associated with lifetime electronic cigarette use (p=0.03) and marijuana use (p=0.01). Greater interpersonal support was negatively associated with days of alcohol intake over the past month (p=0.05). Higher resilience scores were negatively associated with marijuana use (p<0.01) and past two-week binge drinking (p=0.05). Depression (OR 1.31, 95% CI 1.04-1.66), illness acceptance (OR 0.96, 95% CI 0.91-0.99), and resilience (OR 0.32, 95% CI 0.17-0.60) persisted as predictors of marijuana use after adjustment for age and sex.


      The prevalence of alcohol and other substance use is significant among college youth with T1D. While psychosocial factors such as depression and anxiety may confer an increased risk of engaging in these behaviors, others such as illness acceptance, interpersonal support, and resilience may be protective – especially against marijuana use. Providers should address these psychosocial factors in order to curb unhealthy substance use and the complications that may ensue in this vulnerable population.

      Sources of Support

      Boston Children’s Hospital Awards Committee Pilot Research Project Funding (FP01017994), UCLA Children’s Discovery and Innovation Institute (CDI) Research Recognition Award, and National Institutes of Health Career Development Award (NIH/NIDDK K01DK116932).