Predictors and consequences of prescription drug misuse during middle school
Introduction
Nonmedical prescription drug use (NMPDU) has reached epidemic proportions in the United States (McHugh et al., 2015), and is a growing public health problem among adolescents (Ford and Watkins, 2012). NMPDU is typically defined as using prescription drugs without a medical doctor's prescription for personal use, in a way other than prescribed, or for the experience or feelings that it elicits. Steep increases occur from 8th to 12th grade in past year non-medical use of prescription drugs such as Adderall, OxyContin, Ritalin, and Vicodin (Miech et al., 2015). This suggests that middle school students (i.e., 6th–8th graders) may be exposed to risks for future use or may be contemplating use in the near future. Studies are needed to identify risk and protective factors for NMPDU that can be targeted in prevention efforts for middle school students, as well as to understand the consequences of early NMPDU initiation on different domains of functioning during high school.
Most of what is known about the risk and protective factors for drug use during adolescence comes from studies of substances other than prescription drugs. Studies examining the correlates of adolescent NMPDU have mostly been cross-sectional studies of high school students or samples combining middle and high school students (Young et al., 2012). Given developmental changes during adolescence, longitudinal studies of middle school students are needed to identify individual, peer and family factors relevant to NMPDU initiation in this younger age group. For example, adolescents who perceive themselves as popular tend to engage in more substance use (Allen et al., 2005, Ober et al., 2013, Tucker et al., 2013), perhaps as a way of maintaining their social status, as do those who feel less efficacious at resisting substances (Hiemstra et al., 2012, Ober et al., 2013). Although low resistance self-efficacy is likely relevant to NMPDU, popularity may be less of a risk factor for NMPDU than substances typically used in social settings such as alcohol. Both of these individual factors have been understudied in the context of NMPDU (Nargiso et al., 2015). Peer factors associated with adolescent NMPDU include exposure to drug use and pro-drug attitudes (Ford, 2008a, Ford and Hill, 2012). However, other peer factors largely overlooked in studies of NMPDU include receiving substance offers (Ellickson et al., 2004, Siegel et al., 2015) and overestimating peer use (D’Amico and McCarthy, 2006, Ober et al., 2013, Wu et al., 2015), although the prevalence of NMPDU overestimation has been documented (McCabe, 2008, Sanders et al., 2014). Family factors relevant to NMPDU include poor parental monitoring and involvement (Ford, 2009, Ford and McCutcheon, 2012). Exposure to family member substance use (Chan et al., 2013, Ober et al., 2013) and weaker family values (Shih et al., 2012, Soto et al., 2011, Unger et al., 2002) have also been identified as important risk factors for other forms of adolescent substance use and thus may be useful in understanding NMPDU initiation.
Cross-sectional studies indicate that adolescent NMPDU is associated with weaker academic orientation (Ford, 2009, Havens et al., 2011, McCabe et al., 2004), greater delinquency (Boyd et al., 2009, Ford, 2008b), and other substance use (Ford, 2009, Ford and McCutcheon, 2012, Havens et al., 2011, McCabe et al., 2004, McCabe et al., 2007). Few longitudinal studies have examined how NMPDU initiation is associated with later adolescent functioning. One study of 7th–11th grade students found that those who engaged in nonmedical use of prescription opioids were more likely to screen positive for substance abuse 12 months later than abstainers (McCabe et al., 2013), but another study of 14–17 year olds involved in the juvenile justice system did not find that NMPDU predicted greater engagement in various types of delinquency over the same period of time (Drazdowski et al., 2015). The extent to which early NMPDU initiation is a risk factor for academic and behavioral problems as adolescents transition into high school remains an important, yet largely unexplored question. In addition, beyond these outcomes, there has been no research examining whether NMPDU initiation is a risk factor for problems in other domains of functioning in high school, such as mental health and social functioning.
This is the first study to specifically focus on NMPDU initiation during middle school, identifying both correlates of initiation and high school outcomes associated with early initiation, addressing the critical need for longitudinal research in this area (Nargiso et al., 2015, Young et al., 2012). We followed a diverse cohort of middle school students over 4 years (6 waves of data) to address the following research questions: First, to what extent do time-varying individual factors (resistance self-efficacy, perceived popularity), family factors (family substance use, parental respect), and peer factors (offers, approval, and perceived prevalence of substance use) predict initiation of NMPDU during the middle school years? Second, does the strength of the association between these factors and NMPDU initiation change over time? Third, to what extent is NMPDU initiation during middle school associated with high school outcomes in four domains of functioning: mental health, social, academic, and delinquency?
Section snippets
Participants and procedures
Participants were part of the evaluation of CHOICE, a voluntary after-school substance use prevention program (see D’Amico et al., 2012a, D’Amico et al., 2012b for details). All 6th–8th grade students enrolled in16 middle schools across three school districts in southern California were invited to participate. Schools were selected and matched to their nearest neighbor school based on the squared Euclidean distance measure, estimated using publicly available information on ethnic diversity,
Psychosocial predictors of initiation during middle school
Results from both the separate block models and the full multivariable model are shown in Table 2. In terms of the time-varying covariates, lower resistance self-efficacy, greater exposure to family substance use, lower parental respect, and more substance use offers from peers were significant risk factors for NMPDU initiation. In addition, perceiving that more of one's peers engaged in substance use at Wave 1 was associated with NMPDU initiation in the full model; this differed somewhat from
Discussion
There has been little longitudinal research to date on NMPDU among middle school students, yet our results suggest that a greater focus on these younger adolescents is warranted. In our sample of nearly 13,000 students from 16 middle schools in Southern California, 1 in every 15 students reported at some point between 6th and 8th grade that they had used or tried prescription medicines such as Ritalin, OxyContin, or Vicodin to get ‘high.’ Although national data indicate some decline in NMPDU
Role of funding source
This work was funded by grants from the National Institute on Alcohol Abuse and Alcoholism (R01AA016577, R01AA020883) to Elizabeth J. D’Amico. The authors wish to thank the districts and schools who participated and supported this project. We would also like to thank Kirsten Becker and Megan Zander-Cotugno for overseeing the survey administrations.
Contributors
Joan Tucker led the design of the study and wrote the first draft of the manuscript. Brett Ewing conducted the analyses and Jeremy Miles developed the analysis plan; both assisted in drafting the manuscript. Regina Shih, Eric Pedersen, and Elizabeth D’Amico assisted in drafting the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interest
No conflict declared.
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