Predicting high risk sexual behaviour in teens

Alcohol and drug use are known contributors to adolescents engaging in dangerous sexual activity; leading to substantial health risks such as unwanted pregnancies, sexually transmitted illnesses, drug overdoses and alcohol poisonings. Yet, research suggests that fewer than half of pediatricians report screening patients for substance use and at-risk sexual behaviour. CRAFFT, the diagnostic test developed and currently being employed at Children's Hospital Boston, allows primary care physicians to accurately screen teens for high risk drug and alcohol use in a matter of minutes. Now, according to a new study appearing in the Journal of Adolescent Health, Children's researchers have established that the CRAFFT diagnostic test can also identify teens that are more likely to be engaging in high risk sexual behaviours.

The studies researchers found that teens who screened positive for substance use had significantly greater odds of having sexual contact after using drugs or alcohol. According to the findings, these teens were more likely to have unprotected sex, multiple sexual partners and even a sexually transmitted illness. The cross-sectional survey consisted of 305 adolescents from ages 12- to 18-years-old in 3 different urban clinics. Participants were asked the CRAFFT questions, and also completed a self-administered questionnaire about high risk sexual behaviours. Of those who screened positive, 42.6% reported having sexual contact without a condom, 26.1% after drinking alcohol, 15.6% after drug use and 21.7% with a partner who had been drinking alcohol.

Developed by the Children's Center for Adolescent Substance Abuse Research, the CRAFFT screen, which refers to the mnemonic acronym in the six screening questions, includes questions such as "do you ever use alcohol or drugs to relax, feel better about yourself, or fit in?" and "do you ever forget things you did while using alcohol or drugs?" Answering "yes" to two or more questions is highly predictive of an alcohol or drug-related disorder and now at-risk sexual behaviour.

"Primary care physicians are on the frontline of identifying adolescents who are at-risk and all should be screened with questions like these at every routine medical visit," says Sharon Levy, MD, co-author of the study and physician in the Adolescent Substance Abuse Program at Children's. "Clinicians should be prepared to discuss high risk sexual behaviours with their patients along with the dangers of engaging in sexual activity while intoxicated. Something as simple as asking an adolescent a few questions during a clinical appointment might make the difference."

The CRAFFT test is routinely administered during adolescent clinical appointments at Children's. All adolescents who take the test receive brief advice on alcohol and drug use, and those who test positive are recommended to further assessment for substance use disorders. The authors suggest that these adolescents also receive counselling to avoid high risk sexual behaviours and sexual activity after alcohol or drug use.