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Nonmedical Use of Prescription Drugs by College Students with Minority Sexual Orientations

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Title: Nonmedical Use of Prescription Drugs by College Students with Minority Sexual Orientations
Language: English
Authors: Duryea, Daniel G., Calleja, Nancy G., MacDonald, Douglas A.
Source: Journal of College Student Psychotherapy. 2015 29(2):147-159.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 13
Publication Date: 2015
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: College Students, Sexual Orientation, Minority Group Students, Drug Abuse, Substance Abuse, Self Destructive Behavior, Drug Use, Predictor Variables, National Surveys, Student Behavior, Health Behavior, Behavior Problems, Gender Differences
DOI: 10.1080/87568225.2015.1008374
ISSN: 8756-8225
Abstract: Results from the 2009 "National College Health Assessment" were analyzed by gender and sexual orientation for college students' nonmedical use of prescription drugs. Male and female students identified as having a minority sexual orientation (gay or bisexual) were significantly more likely to use nonmedical prescription drugs than heterosexual students. College students with a minority sexual orientation were engaged in more high-risk substance using behaviors than their heterosexual peers. Implications for assessment, counseling, and future research are discussed.
Abstractor: As Provided
Number of References: 31
Entry Date: 2015
Accession Number: EJ1058514
Database: ERIC
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  Value: <anid>AN0102171136;85y01apr.15;2019Feb14.13:24;v2.2.500</anid> <title id="AN0102171136-1">Nonmedical Use of Prescription Drugs by College Students With Minority Sexual Orientations. </title> <p>Results from the 2009 National College Health Assessment were analyzed by gender and sexual orientation for college students' nonmedical use of prescription drugs. Male and female students identified as having a minority sexual orientation (gay or bisexual) were significantly more likely to use nonmedical prescription drugs than heterosexual students. College students with a minority sexual orientation were engaged in more high-risk substance using behaviors than their heterosexual peers. Implications for assessment, counseling, and future research are discussed.</p> <p>Keywords: college students; high-risk behaviors; prescription drugs; sexual orientation</p> <p>Nonmedical use of prescription drugs is defined as the use of medical drugs without a prescription or use of medical drugs for recreational purposes (Substance Abuse and Mental Health Services Administration [SAMHSA], [<reflink idref="bib26" id="ref1">26</reflink>]). Considerable attention has been focused on nonmedical use of prescription drugs by teens and young adults, with particular attention paid to accidental deaths caused by increased incidences of opioid dependence and opioid overdoses. In fact, 70% of teen nonmedical prescription users combine prescription opioids with other substances, significantly increasing teens' risk of overdose (McCabe, West, Teter, & Boyd, [<reflink idref="bib17" id="ref2">17</reflink>]). Nonmedical use of prescription drugs also contributes to a number of other problems, including increased likelihood of lower grade-point averages; high-risk use of alcohol, cocaine, and cannabis; heightened risk for driving after drinking; or riding with a drinking driver (McCabe, [<reflink idref="bib12" id="ref3">12</reflink>]; McCabe et al., [<reflink idref="bib16" id="ref4">16</reflink>]; SAMHSA, [<reflink idref="bib23" id="ref5">23</reflink>]). Moreover, recreational use of analgesic, sedative, and stimulant medications solely has led to increased overall health risks and substance use disorders (Centers for Disease Control [CDC], [<reflink idref="bib3" id="ref6">3</reflink>]; National Institute of Drug Abuse [NIDA], [<reflink idref="bib19" id="ref7">19</reflink>]). Data from the <emph>2011 National Survey on Drug Use and Health</emph> (NSDUH) found that nonmedical use of prescription drugs among 18 to 25 year old adults who were not in college was second only to marijuana as the most prevalent illicit drug used (SAMHSA, [<reflink idref="bib25" id="ref8">25</reflink>]).</p> <p>However, there is evidence that the rate for this noncollege population is declining: "In 2011, the rate of current nonmedical use of psychotherapeutic drugs among young adults aged 18 to 25 was 5.0 percent, which was lower than the rates from 2003 through 2010" (SAMHSA, [<reflink idref="bib25" id="ref9">25</reflink>], p. 20). In 2012, the rate continued to be lower (5.3%) than in earlier years (SAMHSA, [<reflink idref="bib26" id="ref10">26</reflink>]).</p> <hd id="AN0102171136-2">COLLEGE AND UNIVERSITY STUDENTS</hd> <p>While the rate for nonstudents may be declining, nonmedical use of prescription drugs by college students continues to be high. In fact, the <emph>2010 Monitoring the Future</emph> (MTF) survey estimated annual prevalence rates among full-time college students for stimulants at 9%, and in the most recent MTF survey, for 2012, up to 11.1% (Johnston, O'Malley, Bachman, & Schulenberg, [<reflink idref="bib9" id="ref11">9</reflink>], [<reflink idref="bib10" id="ref12">10</reflink>]), although narcotics (other than heroin) did decline from 7.2% to 5.4% in 2012 for college students. These data indicate that nonprescription drug use among the subpopulation of 18–25 year olds attending college still remains high, the recent overall decline in narcotics use notwithstanding. Exploring college students' substance use in general, the <emph>National Survey of College Counseling 2012</emph> (Gallagher, [<reflink idref="bib7" id="ref13">7</reflink>]) found that slightly more than a third of directors at university and college counseling centers reported increases in alcohol-related problems, and slightly more than half identified increases in illicit drugs on their respective campuses. Although distinctions were not made for drug classes such as nonmedical use of prescription drugs versus drugs like marijuana, it is likely that opioid use accounted for a significant portion of illicit drug use on campuses (e.g., CDC, [<reflink idref="bib3" id="ref14">3</reflink>]; SAMHSA, [<reflink idref="bib24" id="ref15">24</reflink>]a). McCabe, Teter, and Boyd ([<reflink idref="bib15" id="ref16">15</reflink>]) found that college students' nonmedical use of prescription drugs were greatest for analgesics, followed by stimulants, sedatives, and sleep medications, with males using more than females.</p> <p>Meanwhile, the past 15 years of research into college students' high-risk substance use consistently shows significant differences when data are analyzed by gender, race, and sexual orientation. Thus, differences have been identified for such variables as sexual behavior (Eisenberg & Wechsler, [<reflink idref="bib6" id="ref17">6</reflink>]) and self-identified sexual orientation (Bostwick et al., [<reflink idref="bib2" id="ref18">2</reflink>]; Duryea & Frantz, [<reflink idref="bib5" id="ref19">5</reflink>]). McCabe ([<reflink idref="bib12" id="ref20">12</reflink>]) found that college students who reported nonmedical prescription use of benzodiazepines were more likely to be White, engage in same and opposite sex sexual behavior, use other drugs, and participate in other high-risk behaviors.</p> <p>Research also shows the negative consequences of nonprescription drug use. Teter, Falone, Cranford, Boyd, and McCabe ([<reflink idref="bib27" id="ref21">27</reflink>]), examining students' nonmedical prescription use of stimulants, found that approximately half of participants who reported frequent or nonoral use described experiencing depressive symptomology; Zullig and Divin ([<reflink idref="bib31" id="ref22">31</reflink>]) found an association between students' nonmedical use of antidepressants and both depression and increased risk for suicide. Drugs classified as analgesics, sedatives, and stimulants, all frequently prescribed, have a demonstrated potential, both physiologically and psychologically, for misuse, abuse, and dependence by college students (Zacny et al., [<reflink idref="bib30" id="ref23">30</reflink>]). Moreover, there are data linking nonmedical users of prescription drugs, compared to nonusers, to increased use of cannabis, cocaine, and binge drinking, in addition to increases in high-risk behaviors such as driving after drinking and riding with a drinking driver (McCabe, West, Teter, & Boyd, [<reflink idref="bib17" id="ref24">17</reflink>]). For example, an investigation of students' nonmedical use of the stimulant, Adderall, (dextroamphetamine) found that users over the past year were three times more likely to use cannabis, eight times more likely to use cocaine and nonprescribed tranquilizers, five times more likely to use nonprescribed pain relievers, twice as likely to binge drink, and three times more likely to be heavy alcohol users (SAMHSA, [<reflink idref="bib23" id="ref25">23</reflink>]). Similarly, teens that used opioids recreationally were eight times more likely to combine the opioids with marijuana and four times more likely to combine opioids with alcohol (McCabe et al., [<reflink idref="bib17" id="ref26">17</reflink>]).</p> <p>Not all nonmedical use of prescription drugs is solely for recreational use. Some students use stimulants, of course, to facilitate academic achievement due to expected cognitive advantages (Peterkin, Crone, Sheridan, & Wise, [<reflink idref="bib21" id="ref27">21</reflink>]; Rabiner et al., [<reflink idref="bib22" id="ref28">22</reflink>]). One motivation is to extend periods of wakefulness to cram for examinations and complete other academic work. College students also use nonmedical prescription drugs to treat erectile dysfunction. Musacchio, Hartrich, and Garofalo ([<reflink idref="bib18" id="ref29">18</reflink>]) found that 6% of male participants used erectile dysfunction medications to maintain erections or remedy erectile dysfunction. Nearly two thirds of respondents reported erectile dysfunction medication use with other drugs (e.g., alcohol, cannabis, GHB, methamphetamine, and cocaine) and a third with poly-drug use. Four percent of male participants reported lifetime use of erectile dysfunction medications, 1.4% reported current use, and nearly half acknowledged using these medications with alcohol and other illicit drugs (Harte & Meston, [<reflink idref="bib8" id="ref30">8</reflink>]). These findings, similar to findings of young adult opioid use combined with other substances (e.g., McCabe et al., [<reflink idref="bib17" id="ref31">17</reflink>]), highlight college males' dangerous proclivity toward combining drugs and other substances. It should also be noted that erectile dysfunction medication users were more likely to have same-sex partners, reported higher rates of unprotected sex with partners of unknown or positive HIV status, and frequently used these substances with other drugs during sexual activity.</p> <hd id="AN0102171136-3">Sexual Orientation</hd> <p>A number of studies suggest a relationship between sexual orientation and drug use in general. Almost a decade ago, a national survey found elevated lifetime levels of drug use among male and female respondents who identified as gay (Cochran, Ackerman, Mays, & Ross, [<reflink idref="bib4" id="ref32">4</reflink>]). More recently, a study that used a sample of noninstitutionalized members of the general population and was weighted to approximate the gender and racial categories in the United States included a new category coded "other drugs," which included nonmedical prescription drugs (McCabe, Hughes, Bostwick, West, & Boyd, [<reflink idref="bib14" id="ref33">14</reflink>]). Significant differences were found for both gay men and women when compared to heterosexuals.</p> <p>There is evidence that bisexual students are more prone to negative consequences as a result of their alcohol use (Duryea & Frantz, [<reflink idref="bib5" id="ref34">5</reflink>]), consequences that are potentially compounded by nonmedical use of prescription drugs. Moreover, as maintained by Oswalt ([<reflink idref="bib20" id="ref35">20</reflink>]), bisexual men and women are known to experience increased levels of anxiety, mood disorders, suicide, and self-injury. Also, bisexuals may experience <emph>bi-invisibility,</emph> a lack of acknowledgment that bisexuality exists as a legitimate sexual orientation; and <emph>biphobia</emph>, an aversion and fear of bisexuals, which can lead to dual marginalization—prejudice and rejection from both the gay/lesbian and heterosexual communities. These factors may in part explain bisexual students' higher incidence of drinking and nonmedical use of prescription drugs and its associated negative consequences (Duryea & Frantz, [<reflink idref="bib5" id="ref36">5</reflink>]).</p> <p>Escalating nonmedical use of prescription drugs has led to the inclusion of new items to assess this problem in the latest revision of the <emph>National College Health Assessment II</emph> (<emph>NCHA II</emph>) (American College Health Association, [<reflink idref="bib1" id="ref37">1</reflink>]), a survey used by colleges and universities to ascertain the overall health of their students. Our study sought to determine whether these new items indicate sexual orientation differences in nonmedical use of prescription drugs by female and male students.</p> <hd id="AN0102171136-4">METHODS</hd> <p></p> <hd id="AN0102171136-5">Sample</hd> <p>Archival data from the American College Health Association (ACHA) Spring 2009 <emph>NCHA II Reference Group Data</emph> (<emph>n</emph> = 87,105) were analyzed to examine whether significant differences in nonmedical use of prescription drugs were present based on gender and sexual orientation (ACHA, [<reflink idref="bib1" id="ref38">1</reflink>]). Data were aggregated from a national survey of university and college students from 117 institutions (6 outside of the United States) that assessed all students and/or randomly sampled students from participating institutions using the NCHA II. Eighty-five percent of surveys were Web administered, the remainder employing paper and pencil surveys. All institutions had institutional review board approval for inclusion in the reference group data report. Seventy-five public and 42 private institutions were represented (total = 117), with 110 (94%) representing 4-year or above institutions. The data set represented an overall response rate of 30%. Additional details pertaining to the data collection have been published elsewhere (ACHA, [<reflink idref="bib1" id="ref39">1</reflink>]).</p> <p>The median age of the sample was 21 years and the mean 22.33 (<emph>SD</emph> = 5.71) years. Females comprised 63.3% of the sample. Whites were 73.6%, African Americans 5.3%, Hispanics or Latinos 6.6%, Asians or Pacific Islanders 11.4%, American Indians or Alaskan Natives 1.3%, multiracial 3.5%, and others 2.5%; international students comprised 9.6%. Reported sexual orientation was heterosexual 93.1%, gay/lesbian 2.4%, and bisexual, 2.9% (ACHA, [<reflink idref="bib1" id="ref40">1</reflink>]). The data examined for this study came from those cases without any missing data (<emph>N</emph> = 80,621).</p> <hd id="AN0102171136-6">Measures</hd> <p>Six variables were examined: Gender, sexual orientation, nonmedical use of prescription drugs, and substance abuse. Gender responses were "female," "male," and "transgender." Sexual orientation responses were "heterosexual," "gay/lesbian," "bisexual," and "unsure." Data for transgender and unsure responses were not included in analyses, transgender due to the limited number of students (0.2%), and the "unsure" category due to the ambiguity of the response.</p> <p>Nonmedical use of prescription drugs was surveyed by drug classes: "Within the last 12 months, have you taken any of the following prescription drugs that were not prescribed to you?" Choices were "Antidepressants (e.g., Celexa, Lexapro, Prozac, Wellbutrin, Zoloft)"; "Erectile dysfunction drugs (e.g., Viagra, Cialis, Levitra)"; "Pain killers (e.g., OxyContin, Vicodin, Codeine)"; Sedatives (e.g., Xanax, Valium); and "Stimulants (e.g., Ritalin, Adderall)." All responses were either "yes" or "no."</p> <p>Finally, a variable was created to examine whether students have been diagnosed and/or treated for substance abuse (alcohol or other drugs) within the past 12 months. The variable explored whether differences in substance abuse by gender and sexual orientation are associated with differences in nonmedical prescription drug use.</p> <hd id="AN0102171136-7">RESULTS</hd> <p>A chi-square test of association was conducted for each medication class by gender and sexual orientation. Follow-up 2 × 2 contingency tables were calculated to determine which groups significantly differed by gender. In addition, odds ratios with 95% confidence intervals were calculated to estimate effect size.</p> <hd id="AN0102171136-8">Males</hd> <p>As shown in Table 1, significant differences were found for male students on all nonmedical prescription drug classes. Gay and bisexual males had significantly more use of unprescribed antidepressants than heterosexual males (χ<sups>2</sups> = 9.62, <emph>p</emph> =.002 and χ<sups>2</sups> = 14.10, <emph>p</emph> = <.001, respectively). Gay and bisexual male students had significantly more unprescribed use of erectile dysfunction drugs than heterosexual males (χ<sups>2</sups> = 27.90, <emph>p</emph> <.001 and χ<sups>2</sups> = 10.30, <emph>p</emph> =.001, respectively). Bisexual males had significantly more unprescribed use of painkillers than both gay (χ<sups>2</sups> = 13.60, <emph>p</emph> = <.001) and heterosexual males (χ<sups>2</sups> = 27.50, <emph>p</emph> <.001). Both gay and bisexual males' sedative use was significantly greater than heterosexual males (χ<sups>2</sups> = 30.08, <emph>p</emph> <.001, and χ<sups>2</sups> = 17.51, <emph>p</emph> <.001, respectively). The only significant difference in stimulant use was between gay and heterosexual men, with gay men using significantly more than heterosexuals (χ<sups>2</sups> = 8.31, <emph>p</emph> =.004). Gay and bisexual men were significantly more likely to have a diagnosis and/or treatment for substance abuse (χ<sups>2</sups> = 12.00, <emph>p</emph> =.001 and χ<sups>2</sups> = 18.73, <emph>p</emph> <.001, respectively) than heterosexual male students.</p> <p>TABLE 1 Males' Unprescribed Medication Use by Sexual Orientation in Last 12 Months</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td><italic>n</italic></td><td>Expected</td><td>χ<sup>2</sup> (<italic>p</italic>)</td><td>OR</td><td>95% CI</td></tr></thead><tbody><tr><td>Antidepressants</td></tr><tr><td> H</td><td>656</td><td>673</td><td /><td /><td /></tr><tr><td> G</td><td>47</td><td>31</td><td char=".">9.62 (.002)</td><td>1.61</td><td>[1.19, 2.17]</td></tr><tr><td> H</td><td>656</td><td>670</td><td /><td /><td /></tr><tr><td> B</td><td>29</td><td>15</td><td char=".">14.10 (<.001)</td><td>2.04</td><td>[1.96, 2.56]</td></tr><tr><td> B</td><td>29</td><td>25</td><td /><td /><td /></tr><tr><td> G</td><td>47</td><td>51</td><td char=".">1.01 (NS)</td><td /><td /></tr><tr><td>Painkillers</td></tr><tr><td> H</td><td>2595</td><td>2600</td><td /><td /><td /></tr><tr><td> G</td><td>123</td><td>118</td><td char=".">0.27 (NS)</td><td /><td /></tr><tr><td> H</td><td>2595</td><td>2633</td><td /><td /><td /></tr><tr><td> B</td><td>96</td><td>58</td><td char=".">27.50 (<.001)</td><td>1.8</td><td>[1.44, 2.25]</td></tr><tr><td> B</td><td>96</td><td>72</td><td char=".">13.60 (<.001)</td><td>1.71</td><td>[1.28, 2.30]</td></tr><tr><td> G</td><td>123</td><td>147</td><td /><td /><td /></tr><tr><td>Sedatives</td></tr><tr><td> H</td><td>1131</td><td>1173</td><td /><td /><td /></tr><tr><td> G</td><td>95</td><td>53</td><td char=".">30.08 (<.001)</td><td>1.93</td><td>[1.55, 2.40]</td></tr><tr><td> H</td><td>1131</td><td>1152</td><td /><td /><td /></tr><tr><td> B</td><td>46</td><td>26</td><td char=".">17.51 (<.001)</td><td>1.9</td><td>[1.40, 2.60]</td></tr><tr><td> B</td><td>46</td><td>46</td><td /><td /><td /></tr><tr><td> G</td><td>95</td><td>95</td><td char=".">.004 (NS)</td><td /><td /></tr><tr><td>Stimulants</td></tr><tr><td> H</td><td>2044</td><td>2070</td><td /><td /><td /></tr><tr><td> G</td><td>120</td><td>94</td><td char=".">8.31 (.004)</td><td>1.33</td><td>[1.10, 1.60]</td></tr><tr><td> H</td><td>2044</td><td>2053</td><td /><td /><td /></tr><tr><td> B</td><td>54</td><td>46</td><td char=".">1.60 (NS)</td><td /><td /></tr><tr><td> B</td><td>54</td><td>57</td><td /><td /><td /></tr><tr><td> G</td><td>120</td><td>117</td><td char=".">0.29 (NS)</td><td /><td /></tr><tr><td>Erectile Dysfunction</td></tr><tr><td> H</td><td>326</td><td>346</td><td /><td /><td /></tr><tr><td> G</td><td>36</td><td>16</td><td char=".">27.90 (<.001)</td><td>2.5</td><td>[1.75, 3.52]</td></tr><tr><td> H</td><td>326</td><td>335</td><td /><td /><td /></tr><tr><td> B</td><td>16</td><td>7</td><td char=".">10.30 (.001)</td><td>2.3</td><td>[1.40, 3.74]</td></tr><tr><td> B</td><td>16</td><td>17</td><td /><td /><td /></tr><tr><td> G</td><td>36</td><td>35</td><td char=".">.107 (NS)</td><td /><td /></tr><tr><td>Substance Abuse</td></tr><tr><td> H</td><td>348</td><td>362</td><td /><td /><td /></tr><tr><td> G</td><td>30</td><td>16</td><td char=".">12.00 (.001)</td><td>1.93</td><td>[1.32, 2.81]</td></tr><tr><td> H</td><td>348</td><td>360</td><td /><td /><td /></tr><tr><td> B</td><td>20</td><td>8</td><td char=".">18.73 (<.001)</td><td>2.65</td><td>[1.67, 4.19]</td></tr><tr><td> B</td><td>20</td><td>16</td><td /><td /><td /></tr><tr><td> G</td><td>30</td><td>34</td><td char=".">1.19 (NS)</td><td /><td /></tr></tbody></table> </ephtml> </p> <p>3 <emph>Note.</emph> H = heterosexual; G = gay; B = bisexual; OR = odds ratio; CI = confidence interval.</p> <hd id="AN0102171136-9">Females</hd> <p>As shown in Table 2, significant differences were found for all nonmedical prescription drug classes, with the not surprising exception for erectile dysfunction drugs. Overall, findings for female students were similar to those for male students. Both bisexual and lesbian females used unprescribed antidepressants significantly more than heterosexual females (χ<sups>2</sups> = 22.71, <emph>p</emph> <.001 and χ<sups>2</sups> = 13.34, <emph>p</emph> <.001, respectively). Lesbian and bisexual females used unprescribed painkillers significantly more than heterosexual female students (χ<sups>2</sups> = 11.25, <emph>p</emph> = 001 and χ<sups>2</sups> = 149.75, <emph>p</emph> <.001 respectively). Bisexual females used significantly more painkillers than lesbians (χ<sups>2</sups> = 9.13, <emph>p</emph> =.003). Both bisexual females and lesbians used more unprescribed sedatives (χ<sups>2</sups> = 139.70, <emph>p</emph> <.001 and χ<sups>2</sups> = 20.23, <emph>p</emph> <.001). Bisexual females used significantly more stimulants than both heterosexual females and lesbians (χ<sups>2</sups> = 66.0, <emph>p</emph> <.001 and χ<sups>2</sups> = 7.76, <emph>p</emph> =.005, respectively). Significant differences for diagnosed and/or treated substance abuse were found between bisexual females and lesbians compared to heterosexual females (χ<sups>2</sups> = 151.00, <emph>p</emph> <.001 and χ<sups>2</sups> = 41.67, <emph>p</emph> <.001, respectively).</p> <p>TABLE 2 Females' Unprescribed Medication Use by Sexual Orientation in Last 12 Months</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td><italic>n</italic></td><td>Expected</td><td>χ<sup>2</sup> (p)</td><td><italic>OR</italic></td><td>95% CI</td></tr></thead><tbody><tr><td>Antidepressants</td></tr><tr><td> H</td><td>1564</td><td>1581</td><td /><td /><td /></tr><tr><td> L</td><td>40</td><td>23</td><td char=".">13.35 (<.001)</td><td>1.81</td><td>[1.31, 2.50]</td></tr><tr><td> H</td><td>1564</td><td>1599</td><td /><td /><td /></tr><tr><td> B</td><td>91</td><td>56</td><td char=".">22.71 (<.001)</td><td>1.7</td><td>[1.36, 2.09]</td></tr><tr><td> B</td><td>91</td><td>93</td><td /><td /><td /></tr><tr><td> L</td><td>40</td><td>38</td><td char=".">0.13 (NS)</td><td /><td /></tr><tr><td>Painkillers</td></tr><tr><td> H</td><td>3844</td><td>3868</td><td /><td /><td /></tr><tr><td> L</td><td>80</td><td>56</td><td char=".">11.25 (.001)</td><td>1.5</td><td>[1.18, 1.89]</td></tr><tr><td> H</td><td>3844</td><td>3981</td><td /><td /><td /></tr><tr><td> B</td><td>277</td><td>140</td><td char=".">149.75 (<.001)</td><td>2.24</td><td>[1.96, 2.56]</td></tr><tr><td> B</td><td>277</td><td>253</td><td char=".">9.13 (.003)</td><td>1.5</td><td>[1.15, 1.96]</td></tr><tr><td> L</td><td>80</td><td>104</td><td /><td /><td /></tr><tr><td>Sedatives</td></tr><tr><td> H</td><td>3844</td><td>3868</td><td /><td /><td /></tr><tr><td> L</td><td>80</td><td>56</td><td char=".">11.25 (.001)</td><td>1.5</td><td>[1.18, 1.89]</td></tr><tr><td> H</td><td>3844</td><td>3981</td><td /><td /><td /></tr><tr><td> B</td><td>277</td><td>140</td><td char=".">149.75 (<.001)</td><td>2.24</td><td>[1.96, 2.56]</td></tr><tr><td> B</td><td>277</td><td>253</td><td char=".">9.13 (.003)</td><td>1.5</td><td>[1.15, 1.96]</td></tr><tr><td> L</td><td>80</td><td>104</td><td /><td /><td /></tr><tr><td>Stimulants</td></tr><tr><td> H</td><td>1803</td><td>1826</td><td /><td /><td /></tr><tr><td> L</td><td>49</td><td>27</td><td char=".">20.23 (<.001)</td><td>1.94</td><td>[1.45, 2.60]</td></tr><tr><td> H</td><td>1803</td><td>1896</td><td /><td /><td /></tr><tr><td> B</td><td>160</td><td>67</td><td char=".">139.70 (<.001)</td><td>2.7</td><td>[2.25, 3.20]</td></tr><tr><td> B</td><td>160</td><td>148</td><td /><td /><td /></tr><tr><td> L</td><td>49</td><td>61</td><td char=".">3.60 (NS)</td><td /><td /></tr><tr><td>Substance Abuse</td></tr><tr><td> H</td><td>351</td><td>366</td><td /><td /><td /></tr><tr><td> L</td><td>20</td><td>5</td><td char=".">41.67 (<.001)</td><td>4.02</td><td>[2.54, 6.34]</td></tr><tr><td> H</td><td>351</td><td>396</td><td /><td /><td /></tr><tr><td> B</td><td>59</td><td>14</td><td char=".">151. (<.001)</td><td>4.9</td><td>[3.70–6.48]</td></tr><tr><td> B</td><td>59</td><td>56</td><td /><td /><td /></tr><tr><td> L</td><td>20</td><td>23</td><td char=".">.575 (NS)</td><td /><td /></tr></tbody></table> </ephtml> </p> <p>4 <emph>Note.</emph> H = heterosexual; L = lesbian; B = bisexual.</p> <hd id="AN0102171136-10">DISCUSSION</hd> <p>Significant differences were found in all drug classes examined by gender and sexual orientation, as shown in Table 1 and Table 2. Erectile dysfunction drugs significantly differed by sexual orientation specifically for men. The effect size of significant differences are included as odds ratios in Table 1 and Table 2. Significant differences were found between gay and heterosexual males for stimulant use, with gay students using more (χ<sups>2</sups> = 8.31, <emph>p</emph> =.004); however, the effect size was small (i.e., odds ratio = 1.33). Previously, Kadison ([<reflink idref="bib11" id="ref41">11</reflink>]) commented that stimulant use had become a general problem facing all college students and warned against the indiscriminate use of stimulants to gain an academic "edge" (p. 1089). This widespread use may account for the small effect size between gay and heterosexual male students.</p> <p>Gay students were 1.61 and bisexual males were 2.04 times more likely to use unprescribed antidepressants than were heterosexual males. Differences in unprescribed erectile dysfunction medication use were found for gay and bisexual males compared with heterosexual male students, with gay students 2.5 times and bisexual males 2.3 times more likely to use this medication. Gay (1.90 times more likely) and bisexual males (1.93 times) were also significantly more likely to use unprescribed sedatives than were heterosexuals. These findings differ from previous findings showing no significant differences in painkiller use based on sexual orientation for males (McCabe, Hughes et al., [<reflink idref="bib16" id="ref42">16</reflink>]), and as such may reflect a recent trend.</p> <p>Bisexual males and gay students were more likely than heterosexual males to report a substance abuse diagnosis. Gay students were twice as likely to have a substance abuse diagnosis than were heterosexual males, and bisexual males were 2.65 times more likely.</p> <p>Similar to males, bisexual females and lesbians were 1.70 and 1.81 more times likely, respectively, to use unprescribed antidepressants compared with heterosexual female students. Both bisexual females (2.24 times more likely) and lesbians (1.50 times more likely) were significantly more likely than heterosexual female students to use unprescribed painkillers. Moreover, bisexual females and lesbians were 2.70 and 1.94 times more likely, respectively, to use sedatives. Bisexual females were also 1.90 times more likely to use stimulants than heterosexual female students and 1.58 times more likely to use stimulants than lesbians.</p> <p>Overall, then, bisexual male, gay, bisexual female, and lesbian students were significantly more likely to engage in nonmedical use of prescription drugs compared to heterosexual male and female students. In addition, sexual minority groups were significantly more likely to report a diagnosed alcohol and/or other substance abuse problem compared to heterosexual students.</p> <p>These findings support previous research demonstrating differences in substance use by sexual orientation in college students (McCabe, Hughes et al., [<reflink idref="bib16" id="ref43">16</reflink>]) and differences in substance use between bisexual and heterosexual women (Tucker, Ellickson, & Klein, [<reflink idref="bib28" id="ref44">28</reflink>]). These findings also support previous findings for undergraduate gay and bisexual men with regard to use of erectile dysfunction drugs (Harte & Meston, [<reflink idref="bib8" id="ref45">8</reflink>]; Musacchio et al., [<reflink idref="bib18" id="ref46">18</reflink>]). As such, these findings demonstrate the continued challenge faced in addressing this complex issue of substance use among sexual minorities—a challenge that extends to unprescribed medications as well as the traditionally abused substances of alcohol, marijuana, and other illicit drugs.</p> <hd id="AN0102171136-11">Limitations</hd> <p>There are limitations that should be taken into account when considering these findings. The sample was comprised of 63% females and 37% males, compared to the estimate of 54% female and 46% male among full- and part-time college students in 2009 (National Center for Education Statistics, [<reflink idref="bib29" id="ref47">29</reflink>]). Although the sample was large and used random sampling techniques, schools were self-selected and the response rate was 30%. It is not known whether participating schools differed from the overall college student population, or if nonrespondents differed significantly from students who participated. The data were cross-sectional and only interpretable for the point in time they were collected.</p> <p>Students who identified as transgender (0.2%) were not included in the analysis, nor were students who identified their sexual orientation as "unsure" (1.6%). While confidentiality and anonymity was assured to survey respondents, sexual minority groups were potentially underreported due to social desirability effects. Furthermore, dichotomous responses on drug use limited data on drug specificity, frequency of use and amount, and routes of drug administration. Finally, no variables for ethnicity or socioeconomic status, both known to be related to substance use behavior, were examined in this study.</p> <hd id="AN0102171136-12">Implications</hd> <p>These findings confirm the usefulness of the new items incorporated in the NCHA II to detect differences in college students' nonmedical prescription drug use based on gender and sexual orientation. The results support prior research showing that college students with minority sexual orientations are significantly more likely than heterosexual students to engage in high-risk substance use and, of particular relevance to this study, nonmedical use of prescription drugs. We can infer that campus prevention efforts for substance use should be careful to focus on nonprescription drug use and to target sexual minorities.</p> <p>Another clear implication is that assessments at campus counseling and health services regarding alcohol and other drug use should include questions about nonmedical prescription drug use. Also, of course, co-occurring affective disorders (e.g., depression, bipolar, and anxiety disorders) that are frequently associated with high-risk substance use should always be considered when assessing for substance abuse.</p> <p>The developmental nature of sexual identity in late adolescence and early adulthood renders college-age students with minority sexual identities, especially those without a clear and positive sexual identity, vulnerable to psychological distress and hence to heightened risk for substance abuse. Assessment and treatment on campus for substance abuse concerns, including nonprescription drug use, should pay special attention to the vulnerabilities of sexual minority students.</p> <hd id="AN0102171136-13">FUTURE RESEARCH</hd> <p>Sexual orientation is as salient a variable as gender when assessing students' substance use behavior. Since frequent substance use is associated with physical and psychological consequences, it is essential to continue examining differences among sexual orientation categories in all classes of substances, including nonmedical use of prescription drugs. Future analyses of NCHA II data focusing on minority sexual orientations should examine associations of nonmedical use of prescription drugs with alcohol, tobacco, and other illicit drug use and with all aspects of mental health and stress.</p> <p>Efforts should be made to increase the generalizability of the NCHA II findings by employing a random sample of participants. 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  Data: Nonmedical Use of Prescription Drugs by College Students with Minority Sexual Orientations
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  Data: <searchLink fieldCode="AR" term="%22Duryea%2C+Daniel+G%2E%22">Duryea, Daniel G.</searchLink><br /><searchLink fieldCode="AR" term="%22Calleja%2C+Nancy+G%2E%22">Calleja, Nancy G.</searchLink><br /><searchLink fieldCode="AR" term="%22MacDonald%2C+Douglas+A%2E%22">MacDonald, Douglas A.</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+College+Student+Psychotherapy%22"><i>Journal of College Student Psychotherapy</i></searchLink>. 2015 29(2):147-159.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
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  Data: 13
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  Data: 2015
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
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  Label: Descriptors
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  Data: <searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Sexual+Orientation%22">Sexual Orientation</searchLink><br /><searchLink fieldCode="DE" term="%22Minority+Group+Students%22">Minority Group Students</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Abuse%22">Drug Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Substance+Abuse%22">Substance Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Destructive+Behavior%22">Self Destructive Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Use%22">Drug Use</searchLink><br /><searchLink fieldCode="DE" term="%22Predictor+Variables%22">Predictor Variables</searchLink><br /><searchLink fieldCode="DE" term="%22National+Surveys%22">National Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Behavior%22">Student Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Behavior%22">Health Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/87568225.2015.1008374
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 8756-8225
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Results from the 2009 "National College Health Assessment" were analyzed by gender and sexual orientation for college students' nonmedical use of prescription drugs. Male and female students identified as having a minority sexual orientation (gay or bisexual) were significantly more likely to use nonmedical prescription drugs than heterosexual students. College students with a minority sexual orientation were engaged in more high-risk substance using behaviors than their heterosexual peers. Implications for assessment, counseling, and future research are discussed.
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  Data: 31
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  Data: 2015
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1058514
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1058514
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/87568225.2015.1008374
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 13
        StartPage: 147
    Subjects:
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Sexual Orientation
        Type: general
      – SubjectFull: Minority Group Students
        Type: general
      – SubjectFull: Drug Abuse
        Type: general
      – SubjectFull: Substance Abuse
        Type: general
      – SubjectFull: Self Destructive Behavior
        Type: general
      – SubjectFull: Drug Use
        Type: general
      – SubjectFull: Predictor Variables
        Type: general
      – SubjectFull: National Surveys
        Type: general
      – SubjectFull: Student Behavior
        Type: general
      – SubjectFull: Health Behavior
        Type: general
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: Gender Differences
        Type: general
    Titles:
      – TitleFull: Nonmedical Use of Prescription Drugs by College Students with Minority Sexual Orientations
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Duryea, Daniel G.
      – PersonEntity:
          Name:
            NameFull: Calleja, Nancy G.
      – PersonEntity:
          Name:
            NameFull: MacDonald, Douglas A.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2015
          Identifiers:
            – Type: issn-print
              Value: 8756-8225
          Numbering:
            – Type: volume
              Value: 29
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Journal of College Student Psychotherapy
              Type: main
ResultId 1