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

BRIDGID MARIKO CONN, M.A. APRIL 2, 2014 SUFFOLK UNIVERSITY BOSTON, MA

A Cross-Sectional and Mixed Methods Examination of Non-medical Use of Prescription Drugs among Adolescents

Background

 Prescription drug misuse

(NMUPD) is a growing health risk among US adolescents (Compton & Volkow, 2006).

 Unique developmental challenges

• f adolescence may heighten

substance use risk (Haugaard, 2001).

 NMUPD may be viewed as outcome

• f 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

Parent/close friend disapproval of drinking alcohol daily

Study 1: Results

Caucasian adolescents Hispanic adolescents

• Afr. American

adolescents

Parent/close friend disapproval of cigarette smoking daily Parent/ close friend disapproval of trying marijuana Parent/close friend disapproval of smoking marijuana monthly

Decreased NMUPD Risk

Parent/close friend disapproval of smoking marijuana monthly Parent disapproval of drinking alcohol daily

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

Study 2: An Ecological Model

• f 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

• f coding.

 Data were analyzed in two ways:

 Across major socio-ecological agents  Within multiple ecological spheres of influence

• Mental Health/Attitude Towards Mental Health
• Internalized Rx-Related Thoughts and Beliefs
• Personal or Observed NMUPD Experiences

An Ecological Model of Adolescent NMUPD

Macro- system

• Media - Television, Music, Internet

Exo- system

• School – Substance Abuse Norms/Attitude Towards NMUPD
• Doctors/Hospital

Micro- system

• Perceived Parental Rx-Related Thoughts/Beliefs/Modeling
• Parent-Child Rx Drug-Related Communication
• Close Friends/Peers Rx-Related Thoughts/Beliefs/Modeling

Individual

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-

• ld Portuguese, Polish male (--)

Study 2: Results – Intrapersonal

 Perceived risks and benefits

32.0% 22.9% 10.9% 8.6% 5.1% 4.6% 4.0% 2.9%

Necessary for Treatment Help Cope (Emotionally) Only Use if Needed Help Escape/"Numb" Have Fun/Get High Can Make Healthier For Pain Mgmt. For Studying/Focus

Adolescents' Perceived Prescription Drug Benefits

Study 2: Results – Intrapersonal

13.9% 13.4% 12.6% 8.3% 8.0% 7.2% 5.1%

General Risk Death/Overdose Negative Side Effects Seen Neg. Impact on Others Overuse is Harmful Addictive Influences Mood/Behavior

Adolescents' Perceived Prescription Drug Risks

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

31.4% 26.5% 18.6% 9.8% 4.9% 2.9% 2.9% Negative/Risky Get High/Escape Problems For Treatment/Helps "It's Cool" "It's Safe" Ineffective/Doesn't Help For Studying/Focus

Perceived Close Friends' Prescription Drug-Related Beliefs

Study 2: Results - Exosystem

12.7% 12.7% 7.9% 7.9% 4.7% 4.7% 1.6% Health Classes Ineffective Stricter Rx Drug Controls Learn Medical Uses Learn About Misuses Decreasing Misuse at School Peers Encourage Misuse Health Classes Effective

Prescription drug-related codes in the school context

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

23.5% 21.6% 15.7% 15.7% 9.8% 7.8% 5.9% Encourages Consumption Downplaying Negatives Negative Effects Emphasize Positives Only Celebrities Use "It's Cool" Helpful for Treatment

Perceived Media Messages about Prescription Drugs

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

I.

Additional use of the Prescription Medication, Alcohol, and Illicit Drugs Interview for Adolescents

• E.g., expanding questions around religion and spirituality,

range of cultural internalized beliefs about mental health and identity

II.

Measure Development

• Proposed Prescription Drug Beliefs and Attitudes

Questionnaire (RxBAQ) study

• III. Further investigation of an ecological model of adolescent

NMUPD.

• Utilizing the model and measure to implement screeners to

identify adolescents at risk for misuse

Special Thanks

 Mentor: Dr. Amy K. Marks  Committee: Drs. Lance Swenson and Lisa Coyne  Bradley Hospital, especially Dr. C. Sloan Alday  Youth Development in Context Lab, particularly:

 Mary Beth McCullough  Eliza Mina

 My family & the 2008 cohort

References

Compton, W. M., & Volkow, N. D. (2006). Abuse of prescription drugs and the risk

• f addiction. Drug and Alcohol Dependence, 83, S4-S7.

Creswell, J. W., Klassen, A. C., Plano Clark, V. L., & Smith, K. C. for the Office of Behavioral and Social Sciences Research. (August 2011). Best practices for mixed methods research in the health sciences. Washington DC: National Institutes of Health. Haugaard, J. J. (2001). Problematic behaviors during adolescence. New York: McGraw-Hill. Schwartz, S. J., Weisskirch, R. S., Zamboanga, B. L., Castillo, L. G., Ham, L. S., Huynh, Q., . . . Cano, M. A. (2011). Dimensions of acculturation: Associations with health risk behaviors among college students from immigrant families. Journal of Counseling Psychology, 58(1), 27-41. Strauss, A. & Corbin, J. (1990). Grounded theory research: procedures, canons, and evaluative criteria. Qualitative Sociology, 13(1), 3-21. Yoshikawa, H., Wiesner, T. S., Kalil, A., & Way, N. (2008). Mixing qualitative and quantitative research in developmental science: Uses and methodological

• choices. Developmental Psychology, 44(2), 344-354.