A Longitudinal Study of the Motivations for the Non-medical Use of Prescription Drugs in a National Sample of Young Adults

Young adults are most at-risk for the non-medical use of prescription drugs (NMUPD) and many of its associated negative consequences. Understanding this population’s motivations for use can help to inform efforts to reduce NMUPD. Past research has been limited in scope, consisting primarily of cross-sectional work with college students focusing on prescription stimulants. The current study researched how motivations for NMUPD changed over young adulthood using three waves of data from a longitudinal, nationally representative sample of 14,990 19 to 24 year olds in the Monitoring the Future study cohorts collected between 1976 to 2013. Prescription stimulants, central nervous system (CNS) depressants, and opioids were investigated, along with sex and college attendance as potential moderators. Differences in NMUPD motivations for young adults who initiated NMUPD in high school versus in early young adulthood were studied. Additionally, motivation patterns of new users were investigated. Analyses indicated that both recreational and self-treatment motivations commonly were reported over time and across drug classes, with four to five popular motivations acknowledged in each class. In general, generalized estimated equations repeated measure analyses found that NMUPD motivations remained relatively stable across young adulthood, with some reductions for the motivations of experimentation and boredom, and an increase in select self-treatment motivations. Overall, men were more likely to endorse recreational motivations, while women were more likely to endorse self-treatment motivations, though this varied somewhat by prescription drug class. Young adults not enrolled in college courses were more likely to endorse using stimulants non-medically for different reasons than their peers who were enrolled. There also were differences in motivations based on if young adults initiated NMUPD in high school compared to when they were 19/20 years old. However, motivations were fairly consistent across young adult development regardless of when NMUPD was initiated. These data suggest that efforts aimed at preventing or reducing NMUPD in young adult populations should include targets to reduce both self-treatment and recreational motivations; may need to be tailored by prescription drug class, sex, and college attendance status; could start in high school; and can be used for new and continued users across young adulthood

Predictors of problematic non-medical prescription pain and stimulant use

Recent results from a nationally representative sample indicated that young adults exhibited the greatest illicit drug use (SAMHSA, 2013b). The non-medical use of prescription drugs (NMUPD) is the second most commonly reported form of illicit substance use by young adults, preceded only by marijuana (SAMHSA, 2013b). This is a growing public health concern with an estimated 2.4 million Americans engaged in NUMPD for the first time within the past year in 2010, an average of 6,600 initiates per day (SAMHSA, 2013b). Prescription opioid abuse alone was estimated to cost the U.S. $55.7 billion in 2007 (Birnbaum et al., 2011). NMUPD has been linked with abuse and dependence, and a variety of other negative outcomes, including mental illness, (e.g., Bavarian et al., 2013), poor school performance (Arria et al., 2011), emergency room visits (SAMHSA, 2013a, 2013b), more frequent sexual risk behaviors (Benotsch et al., 2011), and death (CDC, 2012; Paulozzi et al., 2012). Additionally, young adults who engage in NMUPD are significantly more likely than their peers to use other illicit drugs and to combine prescription drugs with alcohol and other substances. These practices increase the risk of potentially dangerous drug interactions, and their negative outcomes (Garnier et al., 2009; McCabe et al., 2006; SAMHSA, 2006). Therefore, prevention is key to reducing this great public health concern and its grave costs to society. One way to prevent substance use and abuse is to investigate why specific groups of people use and to target interventions specifically to modifiable predictors. The current study focuses on such potential predictors. The sample included 193 undergraduate students (70.4% female) from diverse ethnic groups (55% White) attending a large public university who endorsed NMUPD of either pain or stimulant medications in the past year. Participants completed an online questionnaire that assessed their ratings of their problematic NMUPD use, sleep problems, emotion regulation difficulties, depressive symptoms, and post-traumatic stress disorder (PTSD) symptoms from reliable and valid measures. Using regression models run separately for users of pain and stimulant medications, emotion regulation difficulties and PTSD symptoms were found to predict non-medical problematic use of both pain and stimulant medications (betas ranged from .22 - .32, ps \u3c .05). Sleep problems and depressive symptoms were found to only predict problematic use of stimulants (betas = .33, ps \u3c .01). When all the significant predictors were entered into a multiple regression for each prescription category, no one predictor was significant above and beyond other predictors (see Table 1). However, PTSD symptoms explained the most variance in both models. These results suggest that all of these predictors are important to consider when investigating NMUPD in young adults. Since results from treatment research investigating abuse of other substances have found that integrated approaches that combine mental health and substance use are more effective than interventions that address substance use and mental health problems separately (e.g., Drake et al., 2008), future prevention and intervention efforts should consider all of the variables investigated. If resources are limited targeting PTSD symptoms may be the most effective.https://scholarscompass.vcu.edu/gradposters/1012/thumbnail.jp

Child welfare involvement and adjustment among care alumni and their children: a systematic review of risk and protective factors

Background Recent research and policy recognize care alumni (i.e., adults formerly in out-of-home care [OHC]) as a population with a high accumulation of disadvantages well into adulthood, often in combination with early parenthood compared to the general population. Objective The aim of this systematic review is to provide an overview on the impact of parental OHC on outcomes for both parents (i.e. parental adjustment, parenting) and their children (i.e. prevalence rates of OHC or child welfare system (CWS) involvement, adjustment, development), as well as protective and risk factors associated with those outcomes. Methods Relevant articles were searched in four electronic databases from conception to 16 February 2022 according to PRISMA guidelines for systematic reviews; supplemented with hand-searched citations from relevant references. Evidence was synthesized via a qualitative summary. Results A total of 38 studies were included (19 quantitative, 14 qualitative, and 5 mixed-methods studies). Studies confirm increased rates of early parenthood among care alumni and an elevated risk of OHC among their children. However, most children remain with their care alumni parents, and some parents were met with the needed support to cope with challenging circumstances. Qualitative studies point to a great need for specialized services, including parenting programs that address past trauma and attachment issues. They also highlight potential protective factors. Conclusions Findings suggest that care alumni parents experience compounding disadvantage, which may increase their children's risk of OHC. More research is needed on child adjustment, and on protective factors that can be leveraged to design effective interventions that decrease transgenerational CWS involvement

Use of prescription drugs and future delinquency among adolescent offenders

Non-medical use of prescription drugs (NMUPD) by adolescents is a significant public health concern. The present study investigated the profile of NMUPD in 1349 adolescent offenders from the Pathways to Desistance project, and whether NMUPD predicted future delinquency using longitudinal data. Results indicated that increased frequency and recency of NMUPD in adolescent offenders are related to some demographic factors, as well as increased risk for violence exposure, mental health diagnoses, other drug use, and previous delinquency, suggesting that severity of NMUPD is important to consider. However, ANCOVA analyses found that NMUPD was not a significant predictor of drug-related, non-aggressive, or aggressive delinquency 12 months later beyond other known correlates of delinquency. Age, sex, exposure to violence, lower socioeconomic status, more alcohol use, and having delinquency histories were more important than NMUPD in predicting future delinquency. These findings suggest that although NMUPD is an important risk factor relating to many correlates of delinquency, it does not predict future delinquency beyond other known risk factors

A Longitudinal Study of the Bidirectional Relations Between Anxiety Symptoms and Peer Victimization in Urban Adolescents

The current study examined bidirectional relations between anxious symptoms and two forms of peer victimization (i.e., overt and relational) within an underrepresented sample of urban adolescents during key transition periods (i.e., elementary to middle school; middle school to high school) and the following 2 years. A predominantly African American sample (91%) of 358 adolescents (56% female, mean age = 12.10 years) living in low-income urban areas were assessed annually across 4 years. Using self-report measures, adolescents reported on their past year experiences of anxiety and peer victimization. Longitudinal path analyses tested progressively complex models for each type of victimization. Anxious symptoms predicted both overt and relational victimization at the time of transition (Wave 1 to Wave 2) and the following year (Wave 2 to Wave 3). Furthermore, whereas previous levels of victimization and future anxious symptoms were positively correlated over time, only relational victimization at Wave 1 predicted anxious symptoms at Wave 2. Prior levels of each construct were the strongest predictor of future outcomes (e.g., anxious symptoms at Wave 1 predicting anxious symptoms at Wave 2). Overall, there was little support for bidirectional relations between anxiety symptoms and peer victimization. Intervention and prevention programs seeking to reduce peer victimization or anxiety should start by targeting the symptom/behavior of interest. Interventions that target anxious thoughts and feelings during these key transition times in adolescence should be assessed as areas of priority

Cumulative Risk, Emotion Dysregulation, and Adjustment in South African Youth

Research on cumulative risk is growing, however, little work has occurred in low- or middle-income countries, and few studies have focused on processes linking risk to outcomes. This study explored relations between components of cumulative risk and adjustment in a sample of 324 South African youth (M age = 13.11 years; SD = 1.54 years; 65% female; 56% Black/African; 14% Colored; 23% Indian; 7% White), and tested competing models of emotion dysregulation as a mediator or moderator of risk-adjustment links. Data was collected from youth and their female caregivers during home interviews. Structural equation models and regression analyses accounting for age and sex contributions revealed that emotion dysregulation mediated associations between sociodemographic risk and internalizing symptoms, externalizing problem behavior, and drug use severity, and moderated links between psychosocial risk and internalizing symptoms and externalizing problem behavior. For the mediator models, sociodemographic risk was associated with impaired emotion regulation, which in turn was linked with heightened adjustment difficulties. For the moderator models, psychosocial risk was linked with adjustment problems only when emotion dysregulation was high. These data indicate the importance of disentangling components of cumulative risk. Future research within the South African cultural context might build on these findings by adapting and testing school- or family-based prevention or intervention programs that include modules on emotion regulation