A Cross-Sectional and Mixed Methods Examination of Non-medical Use - PowerPoint PPT Presentation

A Cross-Sectional and Mixed Methods Examination of Non-medical Use of Prescription Drugs among Adolescents BRIDGID MARIKO CONN, M.A. APRIL 2, 2014 SUFFOLK UNIVERSITY BOSTON, MA

Background  Prescription drug misuse (NMUPD) is a growing health risk among US adolescents (Compton & Volkow, 2006).  Unique developmental challenges of adolescence may heighten substance use risk (Haugaard, 2001).  NMUPD may be viewed as outcome of interaction between neuropsychological predispositions and social factors within a formative, context-based process.

Study Aims  The current study utilized a mixed-method approach to combine qualitative and quantitative methodologies to develop an in-depth understanding of adolescent NMUPD.  The current study aimed to extend the literature in terms of our knowledge and understanding of the dynamic and complex social factors which influence prescription drug-related behavior among diverse adolescents.

Why Mixed Methodology?  Mixed methods research may help identify ways in which cultural mechanisms are related to risk behaviors among specific racial/ethnic groups beyond what has been gathered by quantitative means alone (Schwartz et al., 2011).  Mixed methods is more than collecting both types of data; it is the intentional collection and combination of both strategies to thoughtfully and thoroughly address a research question (Creswell, Klassen, Plano Clark, & Smith, 2011).  Integration maximizes the strengths and minimizes the weaknesses of each type of data (Yoshikawa, Weisner, Kalil, & Way, 2008).

Ethnic/Racial Differences in Parents’ and Close Friends’ Influence on Adolescent Prescription Drug Misuse

Study 1: Participants  12-17 year-old participants  African American/Black (n = 2,486; 14.8%)  Hispanic (n = 3,273; 19.4%)  Caucasian (n = 11,093; 65.8%)  50.8% male  Cross-sectional data analysis – National Survey of Drug Use and Health 2010

Study 1: Results Decreased NMUPD Risk Parent/close friend disapproval of cigarette smoking daily Parent/ close friend disapproval of trying marijuana Caucasian adolescents Parent/close friend disapproval of smoking marijuana monthly Parent/close friend disapproval of drinking alcohol daily Hispanic Parent/close friend disapproval of smoking marijuana monthly adolescents Afr. American Parent disapproval of drinking alcohol daily adolescents

Exploring an Ecological Model of Adolescent Prescription Drug Misuse: A Qualitative Study

Study 2: An Ecological Model of Adolescent Health Risk Behavior Macrosystem (Cultural/Social Factors: Media, Societal Values) Exosystem (Community-Level : Schools, Workplace) Microsystem (Immediate Context: Parents, Peers) Adolescents (Intrapersonal Factors: Mental Health, Personality)

Study 2: Participants  Nineteen 14-17 year-old patients (mean age = 15.4)  57.9% female  Majority of sample was multi-ethnic/multi-racial, including Hispanic, Portuguese, Black, Arabic, Polish, Puerto Rican, and Italian.  Adolescent inpatient unit in a psychiatric hospital in the northeastern United States

Study 2: Methods  Screened through routine intake assessment  “Have you ever taken prescription medication not prescribed to you ?”  Obtained parental consent and adolescent assent  Audio-recorded semi-structured interview – Prescription Medication, Alcohol, and Illicit Drug Interview for Adolescents  Interviews were transcribed and double-checked.

Study 2: Methods  Qualitative analysis using Grounded Theory (Strauss & Corbin, 1990)  Two researchers independently completed coding  Greater than 85% agreement was reached in each stage of coding.  Data were analyzed in two ways:  Across major socio-ecological agents  Within multiple ecological spheres of influence

An Ecological Model of Adolescent NMUPD • Media - Television, Music, Internet Macro- system • School – Substance Abuse Norms/Attitude Towards NMUPD Exo- • Doctors/Hospital system • Perceived Parental Rx-Related Thoughts/Beliefs/Modeling • Parent-Child Rx Drug-Related Communication Micro- • Close Friends/Peers Rx-Related Thoughts/Beliefs/Modeling system Mental Health/Attitude Towards Mental Health • Internalized Rx-Related Thoughts and Beliefs • Individual Personal or Observed NMUPD Experiences •

Study 2: Results – Intrapersonal  Mental health/Attitudes towards mental health “Well, my grandfather took them for a long time and they messed with his head a lot so I was scared of taking ‘ em. Like he has like primary bipolar, and I have bipolar and my mom has bipolar and we all…she takes medication and she’s okay kind of but my grandfather took like tons of medication and he took ‘ em once and they just messed up his life pretty much…like made the depression worse and stuff…so I was scared of taking ‘ em, like I thought I would be depressed for the rest of my life or angry all the time .” – 16 year-old White, Irish male

Study 2: Results – Intrapersonal  Personal or observed prescription drug experiences  “I’ve been like angry since I was like ten years old till like now, like nonstop angry and I finally came here and I feel happy… I think it’s ‘cause of the medication but it actually works; that’s the one thing that really worked so…I think it’s a good thing that meds are getting put out into the world.” – 16 year-old White, Irish male (+)  “…I’ve seen a lot of friends hurt themselves with prescription drugs – I’ve saved two of my friends lives from OD -ing so prescriptions kind of scare me. I’ve seen my mom OD on valium so that’s just something that’s always in the back of my head that if it’s supposed to help me how come it can hurt me at the same time.” – 17 year- old Portuguese, Polish male (--)

Study 2: Results – Intrapersonal  Perceived risks and benefits Adolescents' Perceived Prescription Drug Benefits 2.9% For Studying/Focus 4.0% For Pain Mgmt. 4.6% Can Make Healthier 5.1% Have Fun/Get High 8.6% Help Escape/"Numb" 10.9% Only Use if Needed 22.9% Help Cope (Emotionally) 32.0% Necessary for Treatment

Study 2: Results – Intrapersonal Adolescents' Perceived Prescription Drug Risks 5.1% Influences Mood/Behavior 7.2% Addictive 8.0% Overuse is Harmful 8.3% Seen Neg. Impact on Others 12.6% Negative Side Effects 13.4% Death/Overdose 13.9% General Risk

Study 2: Results - Microsystem  Perceived parental prescription drug-related thoughts, beliefs, and practices (i.e., modeling) “…my mom was definitely stubborn, like you do the right thing. The doctor gives you something, you don’t share it. You don’t take over the amount…She definitely sat us down and explained all the reasons why not to do this and do the right thing, and always take your own and follow prescription drugs and nothing else.” – 17 year-old Black, Polish, English, and Irish male

Study 2: Results - Microsystem Perceived Close Friends' Prescription Drug-Related Beliefs For Studying/Focus 2.9% Ineffective/Doesn't Help 2.9% "It's Safe" 4.9% "It's Cool" 9.8% For Treatment/Helps 18.6% Get High/Escape Problems 26.5% Negative/Risky 31.4%

Study 2: Results - Exosystem Prescription drug-related codes in the school context Health Classes Effective 1.6% Peers Encourage Misuse 4.7% Decreasing Misuse at School 4.7% Learn About Misuses 7.9% Learn Medical Uses 7.9% Stricter Rx Drug Controls 12.7% Health Classes Ineffective 12.7%

Study 2: Results - Exosystem  Doctor/Hospital  Major source of information  Most knowledgeable  Influential in medical prescription drug use “They kind of like manipulate you and the doctor leads you to thinking ‘this definitely works,’ ‘it’ll make you feel better’ but it’s actually just you and they’re just giving you something to think it’s actually helping you.” – 17 year-old Spanish male (--)

Study 2: Results - Macrosystem Perceived Media Messages about Prescription Drugs Helpful for Treatment 5.9% "It's Cool" 7.8% Celebrities Use 9.8% Emphasize Positives Only 15.7% Negative Effects 15.7% Downplaying Negatives 21.6% Encourages Consumption 23.5%

Research and Clinical Implications  Prevention efforts can target major information outlets, such as:  Doctor’s office or hospital/medical setting  Health classes or assemblies at school  Internet or social media campaigns  Support for prevention initiatives focusing on providing information to:  Parents and guardians on how to talk to teens about prescription drug use.  Practitioners and educators who may address prescription drug- related behavior (e.g., adherence, misuse) with teens.

Future Directions Additional use of the Prescription Medication, Alcohol, I. and Illicit Drugs Interview for Adolescents o E.g., expanding questions around religion and spirituality, range of cultural internalized beliefs about mental health and identity Measure Development II. o Proposed Prescription Drug Beliefs and Attitudes Questionnaire (RxBAQ) study III. Further investigation of an ecological model of adolescent NMUPD. o Utilizing the model and measure to implement screeners to identify adolescents at risk for misuse