Research suggests that non-medical prescription drug (NMPD) use is becoming increasingly prevalent, particularly among adolescents. A critical step towards developing effective intervention efforts requires identifying adolescents who are at risk for NMPD use. An extensive literature suggests that both adolescents and adults with elevated anxiety sensitivity (AS) are at greater risk for problematic substance use, and a small body of work has identified similar links with NMPD use specifically among adults. However, most of this literature combines all prescription drugs into a single category, and no work has evaluated the relation between AS and NMPD use among adolescents. The current study endeavors to further this area of research by examining the relation between AS (overall and subscales) and NMPD use among adolescents. The project evaluated 276 adolescents (age 9-19 years) enrolled in a residential treatment program on level of AS, including sub-dimensions (i.e., cognitive, physical, and social), and NMPD use across three categories of drugs: analgesic (e.g., Vicodin®), anxiolytic (e.g., Xanax®), and stimulant (e.g., Adderall®). A series of logistic regression models indicated that overall AS predicted nonmedical analgesic use, but not anxiolytic/sedative or stimulant use. A closer investigation of the AS subscales demonstrated that only the AS social subscale significantly predicted nonmedical analgesic and anxiolytic/sedative use. These results suggest that AS is related to NMPD use among adolescents, highlighting the need for future work to disaggregate the assessment of NMPD use into specific drug classes and explore the subscale dimensions of AS.

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BACKGROUND: The nonmedical use of prescription medications among young people has escalated substantially in recent years. Certain subgroups of adolescents are at greater risk than others, including rural youth, however this has yet to be adequately quantified in Canada, and risk and protective factors in rural communities remain understudied. OBJECTIVES: The first objective of this thesis was to characterize the nonmedical use of prescription drugs in Canadian youth by age, gender, socioeconomic, immigrant and geographic statuses. The second objective was to examine time-use patterns among rural young people as they may relate to their risk of using prescription drugs recreationally. METHODS: Data were obtained from 10,429 youth in grades 9 and 10 across Canada who participated in the 2009/2010 Cycle of the Health Behaviour in School-aged Children survey. Participants documented information about their nonmedical use of opioid pain relievers, stimulants and sedative or tranquilizer medications in the past year. Cross-tabulations and multi-level regression analyses were used to determine proportions and estimate risk by demographic subgroups, and among 2393 rural youth, to examine associations with time-use patterns RESULTS: Females were 1.25 times more likely to report recreational use of pain relievers (95% CI: 1.04-1.51). Lower SES students were 2.41 times more likely to report recreational use of any type of medication (95% CI: 1.94-2.99). Pain reliever use was highest among rural youth living in close proximity to urban centres. Frequent peer time after school and in the evenings was associated with a 1.73 (95% CI: 1.10-2.73) and 2.16 times (95% CI: 1.30-3.60) increased risk of using prescription drugs recreationally, however associations were attenuated when adjusted for other risk factors. Non-participation in extracurricular activities was associated with a 50% increase in risk for nonmedical use of prescription drugs, even when adjusted for other risk factors. CONCLUSIONS: Females, those of low SES and some rural youth, especially those who do not participate in extracurricular activities, are at increased risk for using prescription drugs recreationally. Results from this thesis point to priority areas for public health and education in reducing harms associated with nonmedical use of prescription drugs. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-10-01 22:39:42.815

Thesis (M.A.)--Liberty University, 2009. / Includes bibliographical references.

Background: Canada is the only developed country with universal healthcare but no universal prescription drug coverage. Prescription drug coverage in Canada is often described as a “patchwork” system; eligibility for coverage varies by province and influenced by circumstance. Subsets of the population are eligible for partial or full provincial coverage for their prescription medications through public and/or private coverage. Methods: The extent and factors associated with misreporting of drug insurance and cost-related non-adherence (CRNA) to prescribed medicines were investigated in three study populations: Ontario seniors 65 and over, Quebec seniors 65 and over, and Quebec adults 25-64 using pooled data from the 2015/2016 Canadian Community Health Survey (CCHS). The rationale for these study cohorts was that the vast majority had partial or full coverage for prescription medications from a public and/or private source. The factors associated with CRNA to prescribed medicines were also explored in these three subgroups. Results: There is a degree of misreporting of drug insurance among Ontario seniors (17%), Quebec seniors (18%) and Quebec adults (9%). Quebec adults who declared CRNA to prescribed drugs had twice the odds of misreporting prescription drug coverage (OR 2.1 95% CI 1.3-3.4). Lower-income earners among Ontario seniors (OR 1.8, 95% CI 1.3-2.6), Quebec seniors (OR 1.7 95% CI 1.2-2.6), and Quebec adults (OR 3.4, 95% CI 2.3-5.1) were more likely to misreport coverage. Quebec seniors were more likely to misreport if they had less than a secondary school education (OR 1.4, 95% CI 1.1-1.8). Ontario seniors who were immigrants were more likely to misreport coverage (OR 1.5, 95% CI 1.2-1.8), as were Quebec seniors who were immigrants (OR 2.2, 95% CI 1.4-3.5). Ontario seniors who had a flu shot in the past 12 months (OR 0.7, 95% CI 0.5-9.9) and Quebec adults who had visited a GP in the past 12 months (OR 0.6, 95% CI 0.45,0.77) were less likely to misreport coverage. CRNA to prescribed drugs was reported by Ontario seniors (3.3%), Quebec seniors (2.5%), and Quebec adults (5.3%). Low-income Ontario seniors (OR 2.9, 95% CI 1.5-5.7) and Quebec adults (2.5, 95% CI 1.6-3.8) were more likely to report CRNA to prescribed medicines. Quebec adults with chronic conditions (OR 1.7, 95% CI 1.2-2.4) and those in self-reported poor health (OR 2.4, 95% CI 1.3-4.4) were also more likely to report CRNA to prescribed drugs. Conclusions: There appears to be a socio-economic gradient in misreporting and CRNA among Ontario seniors, Quebec seniors, and Quebec adults. Given most of these subgroups will have coverage, we hypothesize a degree of measurement error among responses. More specifically, respondents who report CRNA to prescribed medicines may reflect measurement error. / Thesis / Master of Science (MSc) / Canada is a country that prides itself on universal healthcare yet lacks an important component - universal prescription drug coverage. Hence, it is often described as a “patchwork system” whereby Canadians must rely on a combination of public and private drugs plans depending upon circumstance. As a result, a proportion of Canadians lack prescription drug coverage and may be unable to afford prescription medications. This study aimed to investigate self-reported knowledge of prescription drug insurance in three populations: Ontario seniors 65 years and over, Quebec seniors 65 years and older, and Quebec adults 25-64 years old. The determinants of misreporting of drug insurance among these study populations was the primary objective of this analysis. The association between cost-related nonadherence (CRNA) to prescribed drugs and misreporting was a key variable in the analysis. Although only a small proportion of respondents reported CRNA to prescribed drugs, Quebec adults 25-64 were more likely to misreport drug coverage if they also reported CRNA. This study has provided some clarity on the factors that influence misreporting of drug insurance by Ontario seniors, Quebec seniors, and Quebec adults. Given health policy decisions are often guided by studies based on this data, researchers may consider a degree of misreporting in responses. Policy should aim to reduce misunderstandings about their drug coverage.

Prescription drug advertisements are commonly seen in magazines and on television, and as a result, the public is familiar with them. Many drug ads are targeted toward older adults, who tend to use more medications, because they suffer from more chronic conditions than younger adults. Nonetheless, the effectiveness of drug advertising at persuading older adults to ask physicians for specific medications remains uncertain. Older adults’ explicit memory for drug ads is poor, but their implicit memory for drug ads may be better. Therefore, older adults may be implicitly persuaded by drug ads even when they cannot explicitly remember seeing them. The current study measured implicit memory with an incidental ratings exercise and an indirect test of preference; explicit memory was measured with intentional studying and a direct test of recognition. The purposes of the study were to compare implicit and explicit memory for drug ads in older and younger adults, to determine whether age differences in memory are affected by salient information or anxiety, and to demonstrate that a test of implicit memory may be useful in estimating advertising effectiveness. The results showed no age difference for implicit memory for drug ads, but an age difference was found for explicit memory for drug ads. However, contrary to hypotheses, neither salient information nor anxiety had an effect on implicit or explicit memory. The results were consistent with previous research demonstrating implicit memory in the absence of explicit memory. Although older adults had slightly worse explicit memory, both implicit and explicit memory for drug ads was generally good in both groups. The results were also obtained within the everyday context of prescription drug advertising, which extends memory research to an important real-world setting. Ethical considerations for research on aging and advertising are discussed. Drug ads are designed to be persuasive, but ads should be carefully designed to inform consumers, rather than to manipulate them. The implicit memory manipulation succeeded in demonstrating that ads are persuasive, suggesting that a complete assessment of advertising effectiveness should include a test of implicit memory.

OBJECTIVE: To review existing PDMP statutes, and to provide recommendations for good legislative drafting that will create effective statutory components that will enhance the function and increase the use of PDMPs. METHODS: This policy review was conducted from July 2014 to December 2014, using articles dated January 01, 2004 to July 01, 2014. All PubMed searches were artificially limited to peer reviewed articles that were available as “free full text.” To ensure a comprehensive review of the policies, statutes from all fifty states were surveyed using the legal database, Westlaw Next. The search used terms associated with PDMPs. Each statute was reviewed by title and content to determine applicability to the study. The list of statutes compiled from Westlaw Next was compared with existing publications that survey PDMP statutes. The recommendations are based on the investigator’s experience and training in law and public health in consultation with a legislative expert, and supported by peer reviewed articles and legislative drafting guides. RESULTS: There are twelve main topical components that are addressed in existing state PDMP statutes. The policy brief’s primary three recommendations are to implement an advisory committee with an outlined membership, impose a duty for the committee to routinely review database information and to report on the findings, mandate practitioners to consult the database prior to administering controlled substances, and enact a PDMP educational component for practitioners. Appendix A of this policy review (attached) provides a full list of the recommendations for effective legislation on all twelve topical components.

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