Elizabeth Austic

Peak ages of risk for starting nonmedical use of prescription stimulants

BACKGROUND To produce population-level, year- and age-specific risk estimates of first time nonmedical use of prescription stimulants among young people in the United States. METHODS Data are from the National Surveys on Drug Use and Health 2004-2012; a nationally representative probability sample survey administered each year. Subpopulations included youths aged 12 to 21 years (n=240,160) who had not used prescription stimulants nonmedically prior to their year of survey assessment. A meta-analytic approach was used to produce population-level age-, year-, and cohort-specific risk estimates of first time nonmedical use of prescription stimulants. RESULTS Peak risk of starting nonmedical use of prescription stimulants was concentrated between ages 16 and 19 years, when an estimated 0.7% to 0.8% of young people reported nonmedical use of these medicines for the first time in the past twelve months. Smaller risk estimates ranging from 0.1% to 0.6% were observed at ages 12 to 15 years and 20 to 21 years. Compared with males, females were more likely to have started nonmedical use of prescription stimulants (odds ratio=1.35; 95% CI, 1.13-1.62), particularly between the ages of 14 and 19. Females showed a peak annual incidence rate of 1% at age 18, while males the same age showed an incidence rate of 0.5%. CONCLUSIONS Peak annual incidence rates for nonmedical use of prescription stimulants were observed between the ages of 16 and 19 years. There is reason to initiate interventions during the earlier adolescent years to prevent youths from starting nonmedical use of prescription stimulants.

Substance Use as a Risk Factor for Sleep Problems Among Adolescents Presenting to the Emergency Department

Objectives:To determine correlates of sleep problems among adolescents. Specifically, to assess the relative strength of associations between sleep problems and dating victimization, reasons for emergency department (ED) visit, depression, unhealthy alcohol use, and other drug use (marijuana, nonmedical use of prescription opioids, stimulants, and tranquilizers). Methods:A total of 1852 adolescents aged 14 to 20 years presenting for care to the University of Michigan Emergency Department, Ann Arbor, Michigan, during 2011–2012, self-administered a computerized health survey. Sleep problems were identified if any of the 4 items on the Sleep Problems Questionnaire were rated by a patient as greater than 3 on a 0 to 5 scale. Adolescents who were too sick to be screened in the ED were eligible to participate in the study during their inpatient stay. Exclusion criteria for baseline included insufficient cognitive orientation precluding informed consent, not having parent/guardian present if younger than 18 years, medical severity precluding participation, active suicidal/homicidal ideation, non-English-speaking, deaf/visually impaired, or already participated in this study on a prior visit. Results:23.5% of adolescents reported clinically significant sleep problems. Female gender, depression, dating victimization, tobacco use, nonmedical use of prescription medication, and an ED visit for medical reasons were each associated with sleep problems among adolescents, even while controlling for age, other types of drug use, receiving public assistance, and dropping out of school. Conclusions:These exploratory findings indicate that ED-based screening and brief intervention approaches addressing substance use and/or dating victimization may need to account for previously undiagnosed sleep problems.

Opioid Use Among Interscholastic Sports Participants: An Exploratory Study From a Sample of College Students

Purpose: Involvement in sports increases the risk for injury and the risk for prescription opioid use and misuse. This was an exploratory retrospective study to examine if previous involvement in interscholastic sports was associated with a greater lifetime prevalence of medical prescription opioid use, lifetime risk for diverting prescribed opioids, and lifetime risk for nonmedical prescription opioid use. Method: A Web-based survey was self-administered to a sample of 4,187 full-time undergraduate students at a large public university located in the Midwest. Student demographics, involvement in interscholastic sports during high school, lifetime medical prescription opioid use, lifetime risk for diverting prescribed opioids, and lifetime risk for nonmedical prescription opioid use were measured and analyzed for this study. Results: Multiple logistic regression analyses indicated that those who participated in at least 1 interscholastic sport during high school had greater odds for lifetime medical prescription opioid use on multiple occasions and greater odds for being approached to divert their prescribed opioid medications on multiple occasions when compared with their peers who did not participate in interscholastic sports during high school. Conclusions: The findings indicate some association between previous involvement in interscholastic sports and prescription opioid use and misuse. These findings further suggest that greater awareness should be instilled in parents and coaches regarding this form of substance misuse.

Diversion of ADHD Stimulants and Victimization Among Adolescents

OBJECTIVE To examine whether a recent prescription for stimulant medication is associated with peer victimization among youth with attention deficit/hyperactivity disorder (ADHD). METHODS Data from 4,965 adolescents attending five public schools who completed an annual web survey over 4 years were used to examine recent stimulant medication prescription and self-reported frequent victimization. RESULTS Adolescents with ADHD and recent stimulant prescription reported more victimization than those without ADHD, but similar to adolescents with ADHD and no recent prescription. Adolescents with ADHD and past 12-month diversion of their prescribed stimulants were at greatest risk of 12-month frequent victimization compared with adolescents without ADHD and adolescents with ADHD but no recent prescription. Youth approached to divert reported more victimization than youth not approached. Youth who diverted reported more victimization than those who did not divert. CONCLUSIONS Close parent-prescriber collaboration is needed to ensure effective medical treatment for ADHD without greater risk for victimization and treatment failure.

The Comparative Impacts of Social Justice Educational Methods on Political Participation, Civic Engagement, and Multicultural Activism

This cross-sectional, repeated measures, quasi-experimental study evaluates changes in college students’ commitment toward, and confidence in, political participation, civic engagement, and multicultural activism. Our sample (n = 653) consisted of college students in a Midwestern university who participated in one of three social justice education course types (service learning, intergroup dialogue, or lecture-based diversity classes) or in an “introduction to psychology” course (the non-intervention group). After completion of a social justice education course, students reported an increase in political participation and multicultural activism, whereas students enrolled in the non-intervention group reported no changes in these measures. Service learning course participants started and ended their course with the highest reported levels of political participation, civic engagement, and multicultural activism but did not demonstrate an increase in any of the three outcomes. Intergroup dialogue participants demonstrated increases in all three outcomes, while participants of lecture-based classes focusing on social justice issues demonstrated increases in political participation and multicultural activism, but not civic engagement. Our findings suggest that participation in social justice education courses is associated with increases in political participation and multicultural activism.

Age and Cohort Patterns of Medical and Nonmedical Use of Controlled Medication Among Adolescents.

Objectives:We identified peak annual incidence rates for medical and nonmedical use of prescription opioid analgesics, stimulants, sedatives, and anxiolytics (controlled medication), and explored cohort effects on age of initiation. Methods:Data were gathered retrospectively between 2009 and 2012 from Detroit area students (n = 5185). Modal age at the last assessment was 17 years. A meta-analytic approach produced age-, year-, and cohort-specific risk estimates of first-time use of controlled medication. Cox regression models examined cohort patterns in age of initiation for medical and nonmedical use with any of 4 classes of controlled medication (opioid analgesics, stimulants, sedatives, or anxiolytics). Results:Peak annual incidence rates were observed at age 16 years, when 11.3% started medical use, and 3.4% started using another persons prescription for a controlled medication (ie, engaged in nonmedical use). In the more recent birth cohort group (1996–2000), 82% of medical users and 76% of nonmedical users reported initiating such use by age 12 years. In contrast, in the less recent birth cohort group (1991–1995), 42% of medical users and 35% of nonmedical users initiated such use by age 12 years. Time to initiation was 2.6 times less in the more recent birth cohort group (medical use: adjusted hazard ratio [aHR] = 2.57 [95% confidence interval {CI} = 2.32–2.85]; nonmedical use: aHR = 2.57 [95% CI = 2.17–3.03]). Conclusions:Peak annual incidence rates were observed at age 16 years for medical and nonmedical use. More recent cohorts reported initiating both types of use at younger ages. Earlier interventions may be needed to prevent adolescent nonmedical use of controlled medication.