Prescription stimulant abuse is a recent drug abuse trend that is becoming a major problem across the United States. Previous research has mainly examined the amount of individuals that are abusing prescription stimulants and has ignored using sociological theory to explain why individuals are abusing these drugs. To address this gap in the literature, this thesis applies the theory of social capital to explain how an adolescents’ family structure can affect the likelihood they will abuse prescription stimulants. Examining survey data from the 2008 The National Survey on Drug Use and Health, it was found that adolescents from single parent households, with minimal parental involvement, are more likely to report abusing prescription stimulants. These findings highlight the influence of family structure and parental involvement in an adolescent’s life, as well as the need for additional research in this area to fully understand prescription stimulant abuse.

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The instrumental misuse of prescription stimulants as "study drugs", particularly by college students, is a serious issue that needs to be further investigated. Using data from a sample of 549 University of Central Florida Orlando students, the current study tested the relationship between prescription stimulant misuse and social learning theory, as well as general strain theory. Approximately 17% of participants reported misusing prescription stimulants for academic purposes at least once in the past year. Findings show support for social learning theory; the number of friends who use prescription stimulants and the individual's attitudes about the effectiveness of the drugs are both significant variables. General strain theory was divided into two parts; the first one tests the relationship between strain and negative affect, while the second tests negative affect, strain and prescription stimulant misuse. Overall, general strain theory was not found to explain prescription stimulant misuse. Also, results showed students who binge drink or use other substances are significantly more likely to report prescription stimulant misuse. Potential implications for these findings are discussed, as well as future research directions.

The illicit use of prescription stimulants among college undergraduates is a prevalent and dangerous problem on college campuses across the United States. Though classified by the U. S. Drug Enforcement Agency as schedule II controlled substances (U.S. Department of Justice, 2008), undergraduates obtain these medications through peers and friends, and report misusing of these stimulants to aid their concentration and studying (DeSantis, Webb, & Noar, 2008). Because extant research concludes that the prevalence of the misuse of prescription stimulants (MPS) peaks among undergraduates, this research was guided by the Theory of Planned Behavior (Ajzen, 1985, 1991) as well as a memorable messages framework (Knapp, Stohl, & Reardon, 1981), and sought to examine the messages that college students recall about MPS, how those messages are associated with student’s intention to use stimulants directly, as well as indirectly through changes in attitudes, normative beliefs, and efficacy, and finally, to examine if receiving a memorable message predicts changes in intention to use, or actual use of stimulants over time. Data for the main study were collected in October 2014, and 137 undergraduate students reported a memorable message about MPS and were retained for analysis. Four weeks later, a follow-up survey was launched, and 89 undergraduates also completed the second survey. Results suggest that undergraduates do recall memorable messages about MPS, and the content focuses on the themes of academics, health outcomes, and responsible use. Additionally, memorable messages tended to be more negative than positive, and came from a variety of sources including close friends and peers, family members, instructors, and medical professionals, to name a few. Further, participants’ attitudes and normative beliefs were positively associated with behavioral intention at Time 1. Additionally, behavioral intention at Time 1 was positively associated with behavioral use at Time 2. The findings from this research provide several practical implications for future health education and promotion campaigns.

The abuse of prescription stimulants among college students is a growing public health concern. While these substances are often viewed as safe, “smart drugs”, they are associated with a number of maladaptive outcomes, ranging from poorer academic performance to cardiovascular incidents and even death. To date, the majority of research on the abuse of these substances have focused on demographic factors which are not amenable to intervention, such as race, Greek organization status, and class rank. The current study examined family factors, academic stress, and impulsivity as potential risk factors which are amenable to intervention. In a sample of 335 undergraduate students, no associations were found between family variables and prescription stimulant abuse or academic stress and prescription stimulant abuse. Inconsistent support was found for an association between impulsivity and prescription stimulant abuse.

The frequency of illicit use of prescription stimulants (IUPS) was examined in relation to known risk factors. A hierarchical linear regression (N = 903) was used to evaluate self-reported past-year IUPS and demographic variables. Gender (p < .05), race (p < .05), and GPA (p < .01) were significantly associated with the frequency of past-year illicit use. However, Greek organization membership status, perceived ADHD symptoms and access to prescription stimulant medication were not significant individual correlates of past-year IUPS. Additional analyses were conducted on the user subgroup (n = 101) to determine whether these relationships were similar compared to the general sample. Among users, ASRS Inattention and Hyperactivity-Impulsivity Subscale scores were significantly associated with the frequency of past-year IUPS (p < .05), even after accounting for gender, race, and GPA. Interpretations of these findings and implications for future research are discussed.

Illicit use of prescription stimulants (IUPS) has become more common in the late adolescent and emerging adulthood populations. This study examined the impact of close friend and parent disapproval/approval on IUPS in college students. A sample of 903 college students (MAge = 19.23) completed a questionnaire assessing variables including lifetime IUPS (14.59% of sample), and perceived close friend/parent disapproval/approval of either academic or recreational IUPS. A 2 X 2 chi-square test of independence was used to analyze data regarding perceived close friend/parent disapproval/approval and IUPS. There were four primary findings. First, students were significantly less likely to report having engaged in IUPS if they perceived close friend (CHI2 (1) = 55.99, p < .001) or parent disapproval (CHI2 (1) = 31.99, p < .001) of IUPS for academic purposes. Second, students were significantly less likely to report having engaged in IUPS if they perceived close friend disapproval of IUPS for recreational purposes (CHI2 (1) = 24.38, p < .001). Third, students were significantly more likely to report having engaged in IUPS if they perceived close friend approval (CHI2 (1) = 51.17, p < .001) and parent approval (CHI2 (1) = 7.87, p = .005) for academically-motivated IUPS. Fourth, students were significantly more likely to report having engaged in IUPS if they perceived close friend approval for recreationally-motivated IUPS (CHI2 (1) = 33.86, p < .001). Future researchers should focus on conducting longitudinal studies to confirm if perceived close friend and parent approval function as risk factors for IUPS and if disapproval functions as a protective factor. Future research is also needed to help identify whether student perceptions of disapproval and approval are accurate (i.e., do close friends and parents really approve or disapprove of IUPS?). Finally, investigators should work to assess whether increased perceptions of disapproval can function to reduce level of IUPS (i.e., not just lifetime prevalence) and whether increases in perceived approval function to exacerbate IUPS. Results of these kinds of research efforts would better inform whether psychoeducational interventions should target decreasing approval and increasing disapproval perceptions in order to both prevent and reduce IUPS behaviors.

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Purpose: Nonmedical use of stimulant medications (NMUS) among college students is an important and growing problem. The annual prevalence of NMUS among four-year college students has nearly doubled since 2008 and exceeds NMUS in non-college peers. Community college students are an understudied population regarding NMUS. Given noted NMUS differences in 4-year students and non-college peers, one cannot assume community college students’ cognitions, perceptions, and behaviors mirror either peer cohort. We conducted a web-based survey across 10 community colleges in Tennessee (TN) to assess correlates and consequences of NMUS. Methods: We developed an initial version of the 60-item survey questionnaire using previously validated, theoretically based survey items and other items developed by the research team. The survey instrument was then reviewed and assessed for content validity by our research team, and thereafter pilot tested with East Tennessee State University undergraduate students for range measures, item order, and best practices for survey construction. The final 55-item survey instrument was designed using web-based survey software (i.e., Qualtrics). Ten of 13 community colleges in TN granted approval for their students to participate in the study (N=53096). A modified Tailored Design Method approach was utilized to maximize response rate across four email contacts, and monetary incentives were offered to encourage participation in the study. Regulatory authorities (e.g., institutional review boards, institutional offices) from East Tennessee State University and participating community colleges approved the conduct of this study. Data were analyzed using SPSS (version 22). Descriptive statistics were calculated to evaluate prevalence, source, motives and consequences of NMUS. Student’s t-tests and chi-square tests were conducted to compare nonmedical stimulant users and nonusers across a number of variables. Results were considered significant for p < 0.05. Results: A total of 3113 students completed the survey (response-rate = 5.8%), of which 302 (9.7%) were past-year nonmedical stimulant users. A significantly greater proportion of users were diagnosed with a mental health condition (22.2%) than non-users (9.6%). Compared to non-users, significantly greater proportions of users reported using tobacco products, such as cigarettes (34.5% vs. 14%), e-cigarettes (12.5% vs. 4%), and vapors (18.4% vs. 6.7%). Users further reported using more types of illicit drugs (1.9 ± 0.1), more alcoholic drinks per week (2.9±0.3), and more occasions of binge drinking per month (1.8±0.2) than non-users (1.1±0.02, 1.3±0.07, 0.7±0.04, respectively). Only 14.2% of users (n=43 from 302) reported having prescriptions for prescription stimulants. Common sources of prescription stimulants were friends (62.9%), family members (12.3%), and street suppliers (9.9%). Commonly endorsed reasons for NMUS were ‘to improve academic performance’ (63.9%), ‘to have more energy’ (49.7 %), ‘to relieve tension’ (22.2%), and ‘to feel good or get high’ (16.6 %). Adverse effects resulting from NMUS included: lack of appetite (45.4%), difficulty sleeping (38.4 %), and racing heart (31.1%). Unlike the published findings from 4-year college students, low GPA, male gender, Caucasian race and membership in fraternity organizations were not associated with NMUS in community colleges. Conclusion: The present study provides useful information on characteristics of users and patterns and consequences of NMUS in community colleges students. NMUS appears to be associated with illicit substance use, binge drinking and disrupted mental health in community college students in TN. Friends are the most common source and desire to enhance academic performance is the most salient motive for NMUS. Despite facing adverse consequences, college students continued using stimulants nonmedically. These findings underscore the need for development of public health programs that target prevention of NMUS in community colleges.

The illicit use of prescription stimulants (IUPS) is a critical Public Health problem in the college population that represents a unique form of substance use. Namely, the primary motives for IUPS by college students are academic in nature (e.g., Teter, McCabe, LaGrange, Cranford, & Boyd, 2006), which may explain why usage rates as high as 43% have been reported on college campuses (Advokat, Guidry, & Martino, 2008). As the field of IUPS is in its infancy, the IUPS-literature lacks 1) a consistent definition of "illicit use of prescription stimulants", 2) an instrument designed to assess the multiple influences on IUPS behavior, and 3) a theoretical lens (Bavarian, 2010a). Accordingly, the goal of this study was to address these research gaps by examining IUPS at one university located in the Pacific Northwest using the theory of triadic influence (TTI; Flay & Petraitis, 1994; Flay, Snyder, & Petraitis, 2009), an integrated, ecological approach to explaining and predicting health behaviors. The study included five phases of research. The first phase began with a systematic approach to measurement development resulting in a 97-item preliminary instrument, the Behaviors, Expectancies, Attitudes and College Health Questionnaire (BEACH-Q). The measure was reviewed by the dissertation committee, leading to revisions in content and structure. During phase II, the BEACH-Q was evaluated by a convenience sample of five health and measurement professionals, and results suggested good content validity of the instrument (i.e. 35 of the 37 TTI-based covariates received a median rating between "agree" and "strongly agree", and 34 received a mean rating between "agree" and "strongly agree"). In phase III (instrument review by a convenience sample of six undergraduates), all 37 covariates received a median and mean rating between "agree" and "strongly agree", confirming good face validity. In phase IV, one undergraduate classroom was selected to participate in a pilot test of the BEACH-Q, using test-retest methodology. Results from the pilot (N = 39) showed that the instrument had moderate to high internal consistency reliability and modest to high stability reliability. In phase V, the final 96-item version of the BEACH-Q was administered throughout campus using one-stage cluster sampling, with classrooms as the sampling unit and students as the observation unit (N = 520 students in 20 classrooms, eligible student response rate = 96.30%). The prevalence of IUPS during college self-reported by the phase V sample was 25.58%, and the probability of engaging in IUPS did not differ between classrooms (Median Odds Ratio = 1.00). In crude logistic regressions, 24 out of 37 hypothesized theoretical covariates were significantly associated with IUPS in the expected direction, suggesting predictive validity of the BEACH-Q. Nested logistic regression analyses illustrated that, for the full multivariate model including ultimate, distal, and proximal covariates, the following measures in the intrapersonal stream were significantly associated with IUPS during college: race/ethnicity, year in school, academic concern, academic grades, diagnosis with Attention Deficit Disorder, and IUPS avoidance self-efficacy. Significant social situation/context stream covariates in the full model included: residence, varsity sports participation, perceptions of IUPS by friends, family, and faculty, endorsement of IUPS by friends, and perceived prevalence of IUPS among friends. With respect to the sociocultural environment stream, in the full multivariate model, the following covariates were found to be significantly associated with IUPS: financial-related stress, participation in religious activities, positive IUPS expectancies, prescription stimulant knowledge and perceived costs/benefits of IUPS. Lastly, intention to engage in IUPS (an immediate precursor) was positively associated with IUPS. Structural equation modeling was used to test models of IUPS for each of the three streams, as well as one integrated model that included covariates from each stream. The models all demonstrated good model fit, and provided insight into the factors that influence (and suggest the mechanisms of causation) intentions to engage in, and ultimately the behavior of, IUPS. In the intrapersonal stream model, inattention was positively associated with academic concern and inversely associated with avoidance self-efficacy, and avoidance self-efficacy was inversely associated with intentions to engage in IUPS. Moreover, intentions to engage in IUPS and avoidance self-efficacy were both significantly associated with IUPS. In the social situation/context stream model, living on-campus was negatively associated with friends' endorsement of IUPS which was positively associated with perceived prevalence of IUPS among friends, and perceived prevalence was positively associated with intentions to engage in IUPS; all of the direct paths to IUPS, excepting the path from perceived prevalence of IUPS among friends, were significant. In the sociocultural environment model, perception of course demand was significantly associated with both the perception that professors give the most attention to top academic students and attitudes about the impact of prescription stimulants on academics, and these attitudes had a positive association with intentions to engage in IUPS. Moreover, the direct paths from attitudes and intentions to IUPS were significant. The mixed model, including participation in religious activities (sociocultural environment stream), friends' endorsement of IUPS (social situation/context stream), and avoidance self-efficacy (intrapersonal stream), also had significant paths from ultimate to distal to proximal to immediate precursor, and significant direct paths to IUPS. This study successfully achieved its goals. First, the instrument developed was theory-driven, broadly defined IUPS, and was psychometrically strong. The cross-sectional study illustrated that IUPS was prevalent on the campus under investigation, as one in four students had engaged in the behavior during college. Associations of use with theoretical correlates were tested for, and structural equation modeling was used to support one premise of the TTI (i.e. that behavior is multifaceted, and covariates from different streams may interact to influence behavior). The findings also suggest that prevention and intervention plans should be multifaceted in nature. Given that this study's cross-sectional nature limited the ability to make causal inferences, future research involving the BEACH-Q should use longitudinal designs. / Graduation date: 2012