Longitudinal effects of universal preventive intervention on prescription drug misuse: three randomized controlled trials with late adolescents and young adults.
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ABSTRACT:
SUBMITTER: Spoth R
PROVIDER: S-EPMC3673263 | biostudies-literature | 2013 Apr
REPOSITORIES: biostudies-literature
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Longitudinal effects of universal preventive intervention on prescription drug misuse: three randomized controlled trials with late adolescents and young adults.
Spoth Richard R Trudeau Linda L Shin Chungyeol C Ralston Ekaterina E Redmond Cleve C Greenberg Mark M Feinberg Mark M
American journal of public health 20130214 4
<h4>Objectives</h4>We examined long-term prescription drug misuse outcomes in 3 randomized controlled trials evaluating brief universal preventive interventions conducted during middle school.<h4>Methods</h4>In 3 studies, we tested the Iowa Strengthening Families Program (ISFP); evaluated a revised ISFP, the Strengthening Families Program: For Parents and Youth 10-14 plus the school-based Life Skills Training (SFP 10-14 + LST); and examined the SFP 10-14 plus 1 of 3 school-based interventions. S ...[more]
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Project description:ObjectiveThis brief report summarizes a replication and extension of a developmental outcome modeling study, by examining whether delayed substance initiation during adolescence, resulting from universal middle school preventive interventions, reduces problematic use in young adults Ages 25 and 27, up to 14.5 years after baseline.MethodParticipants were middle school students from 36 Iowa schools randomly assigned to the Strengthening Families Program plus Life Skills Training (SFP 10-14 + LST), LST-only, or a control condition. Self-report questionnaires originally were collected at 11 time points, through Age 22. A subsequent grant allowed for assessments at Ages 25 and 27, including measures of drunkenness, alcohol-related problems, cigarette use, illicit drug use (lifetime and frequency), marijuana use and prescription drug misuse. These outcomes were modeled as variables influenced by growth factors describing substance initiation during adolescence. Models included the effects of baseline risk, intervention condition assignment, and their interaction; risk-related moderation effects were examined and relative reduction rates were calculated for dichotomous variables.ResultsModel fits were good. Analyses showed significant or marginally significant indirect intervention effects on all outcomes, through effects on adolescent substance initiation growth factors. Intervention × Risk interaction effects favored the higher risk subsample, replicating earlier findings. Additional direct effects on young adult use were observed only for cigarette frequency. Relative reduction rates were larger for the higher risk subsamples, ranging from 3.9% to 36.2%.ConclusionsUniversal preventive interventions implemented during early adolescence have the potential to decrease the rates of substance misuse and associated problems into young adulthood. (PsycINFO Database Record
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Project description:ObjectivesThis study explored adolescents' perspectives on prescription opioids, opioid safety and misuse, and sources of opioid information.MethodsHigh school students participated in focus groups that elicited information about adolescent perspectives on prescription opioids and opioid safety. Demographic information was collected. Focus groups consisted of 5 to 8 student participants and 2 moderators. Focus groups were audio-recorded and professionally transcribed. Transcript content was thematically analyzed using NVivo.ResultsA total of 54 high school students (59% female, 44% white, 44% Latino) participated in 8 focus groups. Participants ranged from ages 14 to 18 years and grades 9 to 12. Five major themes emerged: 1) perceptions of prescription opioids and misuse; 2) prevalence of prescription opioid misuse; 3) reasons for prescription opioid misuse; 4) consequences of prescription opioid misuse; and 5) sources of medication information. Participants identified examples of misuse and reasons for and consequences of teen opioid misuse, including mental and physical health challenges, peer and family influences, and addiction. Sources of opioid-related information included family, peers, online Web sites, and television shows.ConclusionsAdolescents had some knowledge pertaining to prescription opioids, but they had misconceptions related to safety. Participants were aware of safety risks and negative consequences of misuse. Adolescents obtained medication information from various sources, including health care professionals, family and peers, and online sources. Educational efforts that target adolescents should provide opportunities for addressing misconceptions about safe and responsible use of medications.
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Project description:ObjectiveAdolescent controlled prescription drug misuse (PDM) co-occurs with significant consequences, including lower educational achievement, substance use disorder (SUD) symptoms, and psychopathology. Nonetheless, adolescent PDM sources and the prevalence of other substance use, SUD, and mental health outcomes associated with sources remain poorly understood.MethodData were from the 2009 to 2014 National Survey on Drug Use and Health, including 103,920 adolescents (12-17 years of age). Six mutually exclusive sources were used: physician source only, theft/fake prescription only, friend/relative for free only, purchases only, other source only, or multiple sources. Analyses occurred separately for prescription opioids, stimulants, and tranquilizer/sedatives. PDM source prevalence across adolescents and by sex and school enrollment/engagement were estimated. Adjusted odds of past-year DSM-IV substance-specific SUD, marijuana use, any SUD, major depressive disorder (MDD), anxiety diagnosis, mental health treatment, and past-month binge drinking were estimated by source.ResultsFriends/relatives, for free, was the most common source (29.0%-33.2%), followed by physician sources for opioids (23.9%), purchases for stimulants (23.5%), and tranquilizer/sedatives (22.7%). Few school enrollment/engagement differences existed, but female adolescents were more likely to use multiple sources. Over 70% of adolescents using multiple sources had a past-year SUD. Multiple sources, purchases, and theft/fake prescription were more strongly associated with other substance use than physician source use, and multiple source use was linked with MDD.ConclusionAdolescents using multiple sources, purchases and theft/fake prescriptions have elevated rates of other substance use, SUD and MDD and particularly warrant intervention. Also, adolescents with other SUD and MDD should be screened for PDM and misuse sources.
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Project description:BACKGROUND:Prescription opioid misuse has become a leading cause of unintentional injury and death among adolescents and young adults in the United States. However, there is limited information on how adolescents and young adults obtain prescription opioids. There are also inadequate recent data on the prevalence of additional drug abuse among those misusing prescription opioids. In this study, we evaluated past-year prevalence of prescription opioid use and misuse, sources of prescription opioids, and additional substance use among adolescents and young adults. METHODS AND FINDINGS:This was a retrospective analysis of the National Survey on Drug Use and Health (NSDUH) for the years 2015 and 2016. Prevalence of opioid use, misuse, use disorder, and additional substance use were calculated with 95% confidence intervals (CIs), stratified by age group and other demographic variables. Sources of prescription opioids were determined for respondents reporting opioid misuse. We calculated past-year prevalence of opioid use and misuse with or without use disorder, sources of prescription opioids, and prevalence of additional substance use. We included 27,857 adolescents (12-17 years of age) and 28,213 young adults (18-25 years of age) in our analyses, corresponding to 119.3 million individuals in the extrapolated national population. There were 15,143 respondents (27.5% [95% CI 27.0-28.0], corresponding to 32.8 million individuals) who used prescription opioids in the previous year, including 21.0% (95% CI 20.4-21.6) of adolescents and 32.2% (95% CI 31.4-33.0) of young adults. Significantly more females than males reported using any prescription opioid (30.3% versus 24.8%, P < 0.001), and non-Hispanic whites and blacks were more likely to have had any opioid use compared to Hispanics (28.9%, 28.1%, and 25.8%, respectively; P < 0.001). Opioid misuse was reported by 1,050 adolescents (3.8%; 95% CI 3.5-4.0) and 2,207 young adults (7.8%; 95% CI 7.3-8.2; P < 0.001). Male respondents using opioids were more likely to have opioid misuse without use disorder compared with females (23.2% versus 15.8%, respectively; P < 0.001), with similar prevalence by race/ethnicity. Among those misusing opioids, 55.7% obtained them from friends or relatives, 25.4% from the healthcare system, and 18.9% through other means. Obtaining opioids free from friends or relatives was the most common source for both adolescents (33.5%) and young adults (41.4%). Those with opioid misuse reported high prevalence of prior cocaine (35.5%), hallucinogen (49.4%), heroin (8.7%), and inhalant (30.4%) use. In addition, at least half had used tobacco (55.5%), alcohol (66.9%), or cannabis (49.9%) in the past month. Potential limitations of the study are that we cannot exclude selection bias in the study design or socially desirable reporting among participants, and that longitudinal data are not available for long-term follow-up of individuals. CONCLUSIONS:Results from this study suggest that the prevalence of prescription opioid use among adolescents and young adults in the US is high despite known risks for future opioid and other drug use disorders. Reported prescription opioid misuse is common among adolescents and young adults and often associated with additional substance abuse, underscoring the importance of drug and alcohol screening programs in this population. Prevention and treatment efforts should take into account that greater than half of youths misusing prescription opioids obtain these medications through friends and relatives.
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Project description:ObjectivesThis study explored adolescents' awareness about prescription opioid misuse, sources of medication information, and educational preferences.DesignAn online survey explored adolescents' understanding and perceptions of prescription opioids and opioid misuse and safety, medication information sources, and educational preferences.Setting and participantsEligible participants included students from 3 Wisconsin high schools who could speak and understand English. Participants were recruited through "backpack mail" and completed surveys online at school.Outcome measursSurvey responses were compared across demographic information of the study participants. Binary response items were compared across demographic strata by Fisher exact tests, and Likert responses were analyzed by Kruskal-Wallis tests.ResultsA total of 190 students (53% female, 53% white, 32% Hispanic) were surveyed. Most (83.5%) considered using someone else's opioid medication to be misuse, 85.2% identified using opioids at a higher dose or frequency than prescribed as misuse, and 67.6% considered using an opioid prescription after its expiration date to be misuse. Approximately 90% of students perceived that opioid misuse causes some, quite a bit, or a great deal of harm to a person's physical and mental health and school ability. Many students were able to correctly identify examples and consequences of misuse, however 24.7% believed that flushing opioids down the drain was dangerous. The most common source for finding information about opioids was Google or other search engines (67.6%), followed by talking with parents (56.7%), talking with a doctor or nurse (54.9%), and online videos (42.3%).ConclusionAdolescents have some opioid safety knowledge, but there is a clear opportunity to increase knowledge and understanding of risks. Adolescents could benefit from opioid safety education, particularly on safe storage and disposal, harms of misuse, and strategies for discouraging peer opioid misuse.
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Project description:BACKGROUND:Prescription drug misuse is most prevalent during young adulthood (ages 18-25 years). We aimed to identify prescription drug misuse trajectories for three drug classes (opioids, stimulants, and sedatives or tranquilisers) from adolescence into adulthood, assess the extent to which different trajectories are associated with symptoms of substance use disorder, and identity factors associated with high-risk prescription drug misuse trajectories. METHODS:For this longitudinal multicohort study, nationally representative probability samples of 51?223 adolescents in the USA were followed up across eight waves from age 18 years (cohorts 1976-96) to age 35 years. Data were collected via self-administered paper questionnaires. FINDINGS:Five prescription drug misuse trajectories were identified and the defining characteristic that differentiated the five trajectories was the age when past-year prescription drug misuse high frequency peaked: rare or no misuse at any age, peak at age 18 years, peak at ages 19-20 years, peak at age 23-24 years, and peak at ages 27-28 years. Similar prescription drug misuse trajectories were identified for each prescription drug class. The later peak misuse trajectory for sedatives and tranquilisers crested at an older age (35 years) than that for the other drug classes. Prescription drug misuse trajectories were all associated with significantly greater odds of having two or more substance use disorder symptoms at age 35 years, especially the later peak trajectories. In controlled analyses, risk factors associated with the high-risk latest peak prescription drug misuse trajectory included high school heavy drinking, cigarette smoking, marijuana use, poly-prescription drug misuse, white race, and not completing a 4-year university degree. INTERPRETATION:Prescription drug misuse trajectories are heterogeneous, and any high-frequency prescription drug misuse is a strong risk factor for development of substance use disorders during adulthood, especially later-peak prescription drug misuse trajectories. These findings might help practitioners identify individuals at greatest risk for substance use disorders and target intervention strategies. FUNDING:National Institute on Drug Abuse, National Institutes of Health.
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Project description:Considering the prevalence and consequences of health-risking sexual behaviors (HRSBs) and STDs among young adults, their prevention is a public health priority. Emerging etiological and prevention outcome literatures suggested study of the long-term effects of universal family-focused interventions on young adult HRSBs and STDs. Although earlier studies have demonstrated intervention impact on adolescent substance misuse, no study has examined universal family-focused intervention effects on young adult HRSBs and STDs via reductions in adolescent misuse. Sixth grade students and their families enrolled in 33 rural Midwestern schools were randomly assigned to experimental conditions. Self-report questionnaires provided data at pretest (Ns = 238, 221, and 208 for the Iowa Strengthening Families Program [ISFP], Preparing for the Drug Free Years [PDFY], and control groups, respectively), with seven data points through young adulthood (age 21). In latent growth modeling, three young adult HRSB measures (number of sexual partners, condom use, substance use with sex) and lifetime STDs were specified as distal outcomes mediated by adolescent substance initiation growth factors (average level and rate of change). Results showed that the models fit the data and, except for condom use, there were significant indirect effects, with a higher frequency of significant findings for ISFP. The model additions of direct intervention effects on young adult outcomes generally were not supported, consistent with a model positing that long-term intervention effects on young adult HRSBs and STDs outcomes are indirect. As an indication of the practical significance of long-term effects, analyses revealed relative reduction rates ranging from 6% to 46% for significant outcomes.
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Project description:For many substances, more frequent and problematic use occurs in young adulthood; these types of use are predicted by the timing of initiation during adolescence. We replicated and extended an earlier study examining whether delayed substance initiation during adolescence, resulting from universal preventive interventions implemented in middle school, reduces problematic use in young adulthood.Participants were middle school students from 36 Iowa schools randomly assigned to the Strengthening Families Program: For Parents and Youth 10-14 (Molgaard, Spoth, & Redmond, 2000) plus Life Skills Training (LST; Botvin, 1995, 2000), LST-only, or a control condition. Self-report questionnaires were collected at 11 time points, including 4 during young adulthood. The intercept (average level) and rate of change (slope) in young adult frequency measures (drunkenness, alcohol-related problems, cigarettes, and illicit drugs) across ages 19-22 were modeled as outcomes influenced by growth factors describing substance initiation during adolescence. Analyses entailed testing a 2-step hierarchical latent growth curve model; models included the effects of baseline risk, intervention condition assignment, and their interaction.Analyses showed significant indirect intervention effects on the average levels of all young adult outcomes, through effects on adolescent substance initiation growth factors, along with Intervention × Risk interaction effects favoring the higher risk subsample. Additional direct effects on young adult use were observed in some cases. Relative reduction rates were larger for the higher risk subsample at age 22, ranging from 5.8% to 36.4% on outcomes showing significant intervention effects.Universal preventive interventions implemented during early adolescence have the potential to decrease the rates of substance use and associated problems into young adulthood.
| S-EPMC4229488 | biostudies-literature
Project description:BackgroundPrescription drug misuse (PDM) rates are highest in adolescents and young adults. Little research in these high-risk groups has examined PDM differences by educational status or attainment. This investigation attempted to further our understanding of adolescent and young adult prescription drug use and misuse through examining PDM type (i.e., nonmedical misuse, medical misuse and mixed misuse) and substance use disorder (SUD) symptoms from PDM by educational status/attainment.MethodsData were from the 2015 National Survey on Drug Use and Health, with 13,585 adolescent and 14,553 young adult respondents. Participants were categorized by educational status separately in adolescents and young adults. Outcomes were rates of past-year prescription drug use, PDM, PDM type, and SUD symptoms, with analyses performed separately by age group and for opioids, stimulants and sedatives/tranquilizers. Analyses used logistic regression and controlled for age, race/ethnicity and sex.ResultsIn adolescents and across medication classes, the highest rates of any use, PDM, medical misuse, nonmedical misuse and presence of two or more SUD symptoms were seen in those with poor school adjustment or not in school. In young adults, opioid-PDM and related outcomes were more prevalent in those not in school, especially high school dropouts. For stimulants, rates were highest in full-time college students and college graduates.ConclusionsThese results further suggest the importance of assessing educational status in adolescent and educational attainment in young adult PDM investigations. Adolescents poorly engaged in school or not in school appear especially in need of interventions to limit PDM and associated SUD symptoms.
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