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Motives for Nonmedical Use of Prescription Stimulants in Community College Students

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Title: Motives for Nonmedical Use of Prescription Stimulants in Community College Students
Language: English
Authors: Hannah G. Mitchell, Shelby A. King, Meredith K. Ginley, Kelly N. Foster, Nicholas E. Hagemeier, Rajkumar J. Sevak (ORCID 0000-0003-4354-5054)
Source: Journal of American College Health. 2024 72(9):3556-3563.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 8
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Two Year Colleges
Descriptors: Drug Abuse, Stimulants, Student Motivation, Gender Differences, Community College Students, Student Characteristics, Rural Urban Differences, Age Differences, Health Behavior
DOI: 10.1080/07448481.2023.2180997
ISSN: 0744-8481
1940-3208
Abstract: Objective: The present study identified common motives for nonmedical use of prescription stimulants (NMUS) among community college (CC) students and examined behavioral and demographic correlates of certain motives. Participants: The survey was completed by 3,113 CC students (72.4% female; 81.7% White). Methods: Survey results from 10 CCs were evaluated. Results: NMUS was reported by 9% (n = 269) participants. The most common motive for NMUS was to "focus on studies or to improve academic performance" (67.5%) followed by to "have more energy" (52.4%). Females were more likely to report NMUS for weight loss, and males were more likely to report NMUS to experiment. The motive "to feel good or get high" was linked to polysubstance use. Conclusions: CC students report similar motives for NMUS to those commonly endorsed by 4-year university students. These findings may help identify CC students susceptible to risky substance use.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1452238
Database: ERIC
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  Value: <anid>AN0181109515;acl01dec.24;2024Nov28.03:47;v2.2.500</anid> <title id="AN0181109515-1">Motives for nonmedical use of prescription stimulants in community college students </title> <p>Objective: The present study identified common motives for nonmedical use of prescription stimulants (NMUS) among community college (CC) students and examined behavioral and demographic correlates of certain motives. Participants: The survey was completed by 3,113 CC students (72.4% female; 81.7% White). Methods: Survey results from 10 CCs were evaluated. Results: NMUS was reported by 9% (n = 269) participants. The most common motive for NMUS was to "focus on studies or to improve academic performance" (67.5%) followed by to "have more energy" (52.4%). Females were more likely to report NMUS for weight loss, and males were more likely to report NMUS to experiment. The motive "to feel good or get high" was linked to polysubstance use. Conclusions: CC students report similar motives for NMUS to those commonly endorsed by 4-year university students. These findings may help identify CC students susceptible to risky substance use.</p> <p>Keywords: Community college students; motives; nonmedical drug use; stimulants</p> <hd id="AN0181109515-2">Introduction</hd> <p>Nonmedical use of prescription stimulants ([NMUS], eg methylphenidate [Concerta, Ritalin], dextroamphetamin, and amphetamine [Adderall]) is an ongoing public health concern.[<reflink idref="bib1" id="ref1">1</reflink>] NMUS is an increasingly common form of substance use among 4-year university students.[<reflink idref="bib2" id="ref2">2</reflink>] Self-report survey data has found that between 6.9% and 14.0% of college students have engaged in NMUS in the past year.[[<reflink idref="bib3" id="ref3">3</reflink>], [<reflink idref="bib5" id="ref4">5</reflink>]] Compared to same-aged peers not attending college, 4-year university students are more than twice as likely to report NMUS.[<reflink idref="bib4" id="ref5">4</reflink>] The NMUS is costly to the individual, the healthcare system, and academic institutions.[<reflink idref="bib1" id="ref6">1</reflink>],[<reflink idref="bib6" id="ref7">6</reflink>] Among young adults, NMUS is linked to high emergency room utilization, drug overdose, poor academic performance, and lower rates of successful college completion.[[<reflink idref="bib5" id="ref8">5</reflink>], [<reflink idref="bib7" id="ref9">7</reflink>], [<reflink idref="bib9" id="ref10">9</reflink>]] Students reporting NMUS are also more likely to use alcohol, cocaine, marijuana, ecstasy, and nicotine.[<reflink idref="bib5" id="ref11">5</reflink>]</p> <p>Despite accounting for 40% of all undergraduate enrollment, little research attention has been given to nonmedical substance use among community college (CC) students.[<reflink idref="bib10" id="ref12">10</reflink>] Compared to 4-year university students, CC students are more likely to belong to racial and/or ethnic minority groups, be older, socioeconomically disadvantaged, and maintain full-time employment while taking classes.[<reflink idref="bib10" id="ref13">10</reflink>] The combined effect of socioeconomic disadvantage and low health service utilization may account for the higher prevalence of mental health and substance use concerns among CC students compared to their same-age counterparts.[<reflink idref="bib11" id="ref14">11</reflink>],[<reflink idref="bib12" id="ref15">12</reflink>]</p> <p>Underlying motives for nonmedical substance use may predict prognosis.[<reflink idref="bib13" id="ref16">13</reflink>],[<reflink idref="bib14" id="ref17">14</reflink>] Motivational models of substance use suggest that individuals use substances to achieve a certain benefit or outcome, and that the specific desired benefit or outcome alters decisions regarding substance use.[<reflink idref="bib14" id="ref18">14</reflink>],[<reflink idref="bib15" id="ref19">15</reflink>] Motives for substance use are often conceptualized as continuums spanning internal to external sources of motivation and positive to negative types of reinforcement.[<reflink idref="bib15" id="ref20">15</reflink>] The association between motivational models and behavioral markers of substance use has empirical evidence.[<reflink idref="bib5" id="ref21">5</reflink>],[<reflink idref="bib16" id="ref22">16</reflink>] Motives to get high, control appetite, or enhance the effect of other drugs were found to be associated with more dangerous routes of drug administration (ROA), and social conformity motives were linked with high-risk sexual behaviors.[<reflink idref="bib5" id="ref23">5</reflink>],[[<reflink idref="bib17" id="ref24">17</reflink>], [<reflink idref="bib19" id="ref25">19</reflink>]]</p> <p>Research has posited the clinical benefit of pairing treatment with specific motives, particularly in the case of alcohol use.[<reflink idref="bib17" id="ref26">17</reflink>],[<reflink idref="bib20" id="ref27">20</reflink>] For instance, drinking-motive-tailored interventions have been implemented with some success.[<reflink idref="bib20" id="ref28">20</reflink>] It may similarly be beneficial to assess and address motives for NMUS among individuals seeking treatment for problems related to stimulant use. The most often reported motive for NMUS among 4-year university students is to improve academic performance,[<reflink idref="bib5" id="ref29">5</reflink>],[<reflink idref="bib21" id="ref30">21</reflink>],[<reflink idref="bib22" id="ref31">22</reflink>] followed by "self-medication."[<reflink idref="bib23" id="ref32">23</reflink>] However, it is plausible that CC students are motivated to engage in NMUS for different and distinct reasons. The CC students are more likely to be underinsured or uninsured than their 4-year university counterparts, potentially leaving them more susceptible to undertreatment and therefore self-medication.[<reflink idref="bib24" id="ref33">24</reflink>],[<reflink idref="bib25" id="ref34">25</reflink>] Compared to 4-year university students, CC students also report more severe psychological issues yet comparable rates of attention-deficit hyperactivity disorder (ADHD).[<reflink idref="bib11" id="ref35">11</reflink>],[<reflink idref="bib26" id="ref36">26</reflink>] As such, CC students may be more likely to report NMUS with the motive of self-medicating rather than improving academic performance as compared to 4-year university students. An empirical examination of motives for NMUS among CC students could therefore provide useful information.</p> <hd id="AN0181109515-3">The present study</hd> <p>To further understand patterns of NMUS among CC students, the present study examined survey data collected from students within 10 CCs in a southeastern state in the United States (US). The following research questions were posed:</p> <p></p> <ulist> <item> What overall trends exist regarding motives for NMUS among CC students?</item> <p></p> <item> Do motives for NMUS differ based on demographic characteristics (ie gender, attending school in a rural or urban environment, age)?</item> <p></p> <item> Do specific motives for NMUS predict riskier NMUS behaviors (ie a non-oral ROA, polysubstance use)?</item> <p></p> <item> Are participants with a greater number of motives for NMUS likely to report riskier NMUS behaviors (ie more frequent NMUS or a non-oral ROA)?</item> </ulist> <p>It was hypothesized that improving academic performance would be the most common motive for NMUS. Examination of the relation between motives for NMUS and demographic characteristics was exploratory, and therefore specific hypotheses were not posited for this research question. Participants engaging in NMUS with motives of getting high, controlling appetite, or enhancing the effect of other drugs were expected to use risker, non-oral ROAs (ie snorting or smoking)[<reflink idref="bib5" id="ref37">5</reflink>] and be more likely to engage in polysubstance use. Participants with a greater number of motives for NMUS were expected to engage in NMUS more frequently and use a non-oral ROA than individuals with fewer motives for NMUS.</p> <hd id="AN0181109515-4">Materials and methods</hd> <p></p> <hd id="AN0181109515-5">Participants</hd> <p>The complete study protocol is presented in another manuscript.[<reflink idref="bib27" id="ref38">27</reflink>] Students ≥18 years old enrolled in any of the 10 CCs within a State Board of Regents system were eligible to participate in this study. Students were contacted 4 times to prompt study enrollment. The Tailored Design Method (TDM) was adapted for Web-based surveys and implemented to increase response rate.[<reflink idref="bib28" id="ref39">28</reflink>] Informed consent was obtained from each participant prior to enrollment in the study. Participants were offered entry into a drawing for the chance to win 1 of 10 $500 prizes for their participation in the study. The study university's Institutional Review Board (IRB) approved all study procedures.</p> <hd id="AN0181109515-6">Survey</hd> <p></p> <hd id="AN0181109515-7">Assessing for substance use</hd> <p>For the purposes of this study, NMUS was defined as either the use of a prescription stimulant by someone who has not been prescribed the drug or the use of a prescription stimulant in a manner other than how it is prescribed (eg taking more frequent or larger doses than prescribed, administering the drug via non-prescribed route such as inhaling the drug). NMUS was evaluated by asking participants if they have nonmedically used a prescription stimulant in the past 12 months. Participants were not asked about nonmedical use of other medications (eg opioids, sedatives). The prescribed use of cannabis for medical purposes is prohibited in the state where the research was conducted.</p> <p>The following drugs were considered prescription stimulants in the survey: amphetamine and dexamphetamine (Adderall), armodafinil (Nuvigil) dexamphetamine (Dexedrine), dexmethylphenidate (Focalin), lisdexampfetamine (Vyvanse), methamphetamine (Desoxyn), methylphenidate (Ritalin, Concerta, Metadate, Methylin), modafinil (Provigil), phentermine, (Adipex, Suprenz, Fastin). It was also specified that the use of forms of stimulants legally obtained without the need for a prescription was not considered NMUS (eg the use of No-Doz, Dexatrim).</p> <p>Participants were asked to select which of the following ways they have ever used a prescription stimulant nonmedically: by mouth, inhaling, injecting, smoking, and snorting. Participants were asked to estimate the total number of times they have used prescription stimulants nonmedically in the past 12 months. After data were collected, the frequency of NMUS was classified into one of four categories: only once, less than once per month, monthly but not weekly, and at least weekly. Participants were asked to report which, if any, adverse effects they experienced from NMUS. Choices included difficulty sleeping, dizziness and lightheadedness, headache, irritability, lack of appetite, racing heart, upset stomach, legal consequences/problems with law enforcement, visits to an emergency room or urgent care center, or other adverse effects [please specify].</p> <p>Participants were asked to indicate if they never, rarely, sometimes, or often used any other substances. Response options included cocaine, designer/club drugs, hallucinogens, heroin, inhalants, marijuana, methamphetamine, steroids, or other [please specify].</p> <hd id="AN0181109515-8">Participant characteristics</hd> <p>Demographic characteristics were assessed by asking participants to self-report their age, gender, race/ethnicity, and year in school. Participants were also asked to indicate if they had been diagnosed with a behavioral condition, such as ADHD or eating disorder. Participants indicated which CC they attended. Researchers then coded each CC as being in a rural or urban area based on the Census Bureau's classification (ie Counties with</p> <p>Graph</p> <p> <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mo>≥</mo></mrow></math> </ephtml> 50,000 residents were considered urban, and counties with < 50,000 residents were considered rural).[<reflink idref="bib29" id="ref40">29</reflink>] The county's population where each CC was located was obtained via the Census Bureau's Population Estimates Program.[<reflink idref="bib29" id="ref41">29</reflink>]</p> <hd id="AN0181109515-9">Motives for NMUS</hd> <p>Participants who endorsed NMUS were asked to "Please indicate your reasons for nonmedically using prescription stimulants" and then shown a list of potential reasons. Participants selected "yes" or "no" to indicate if each reason had motivated them to NMUS in the past 12 months. The following options were given as potential motives for NMUS: due to peer pressure; to experiment; to feel good or get high; to focus on studies or to improve academic performance; to have more energy; to improve athletic performance; to lose weight; and to relax or relieve tension.</p> <hd id="AN0181109515-10">Statistical analyses</hd> <p>The IBM SPSS Statistics version 26 was used for conducting statistical analyses. Little's test of missing value analysis was conducted. Given the nonsignificant result of Little's test, the data may be assumed to be missing completely at random (MCAR), therefore permitting the use of listwise deletion.[<reflink idref="bib30" id="ref42">30</reflink>] Descriptive statistics were calculated to explore participants' psychosocial characteristics and prevalence rates of NMUS and related behaviors. Chi-square tests of independence were calculated to examine how motives for NMUS differed between genders and individuals attending school in rural and urban environments. Differences in mean age based on motives for NMUS were calculated using a Welch's <emph>t</emph>-test due to the unequal sample sizes and variances between groups. Chi-square tests of independence were calculated to examine the relation between certain motives for NMUS and participant's ROA. Then, a Welch's <emph>t</emph>-test was implemented to examine the number of substances used for participants reporting certain motives for NMUS. A one-way analysis of variance analysis (ANOVA) was conducted to explore if significant differences existed in the number of motives for NMUS based on frequency of NMUS. Significant covariates were included in this model. The Games–Howell test was conducted <emph>post hoc</emph>. Lastly, a binary logistic regression was performed to estimate the effect of the number of motives on the likelihood of using a non-oral ROA. For all analyses, <emph>p</emph> values less than.05 were considered statistically significant.</p> <hd id="AN0181109515-11">Results</hd> <p>The survey was disseminated to 53,096 CC students. The response rate was 5.86% (<emph>N =</emph> 3,113). Participants were 72.4% females and 27.6% males ranging in age from 18 to 72 years (<emph>M</emph> = 26.9; <emph>SD</emph> = 10.3). Participants identified as White (81.7%), Black (10.7%), Hispanic (4.6%), Asian (2.6%), and "other" (2.1%). NMUS was reported by 9% of participants (<emph>n</emph> = 269). Participants reporting NMUS ranged in age from 18 to 64 years (<emph>M</emph> = 24.8; <emph>SD</emph> = 8.0). More participants reporting NMUS were females (67.7%) than males (31.6%). Most participants reporting NMUS were White (81%), followed by Black (10.4%) and Hispanic (7.1%). More students reporting NMUS attended school in a rural area (56.4%) than in an urban area (43.6%). Students reporting NMUS were mostly in their second year of secondary education (50.9%), followed by first year (39.0%), and other (10.1%). The mean grade point average (GPA) of participants reporting NMUS was 3.18 (<emph>SD</emph> = 0.60) while the average GPA for individuals not reporting NMUS was 3.26 (<emph>SD</emph> = 0.63). The psychosocial characteristics of participants reporting NMUS are presented in Table 1. Further analysis of NMUS relative to psychosocial characteristics using these data is available elsewhere.[<reflink idref="bib27" id="ref43">27</reflink>]</p> <p>Table 1. Characteristics of participants reporting NMUS (<emph>N</emph> = 269).</p> <p> <ephtml> <table><thead><tr><td>Age</td><td /></tr></thead><tbody valign="top"><tr><td> Range</td><td char=".">18–64 years</td></tr><tr><td> Mean (<italic>SD</italic>)</td><td char=".">24.8 (8.0)</td></tr><tr><td>Gender</td><td /></tr><tr><td> Male</td><td char=".">31.6%</td></tr><tr><td> Female</td><td char=".">67.7%</td></tr><tr><td>Ethnicity</td><td /></tr><tr><td> White</td><td char=".">81.0%</td></tr><tr><td> Black</td><td char=".">10.4%</td></tr><tr><td> Hispanic</td><td char=".">19 7.1%</td></tr><tr><td>Grade point average (GPA)</td><td /></tr><tr><td> Mean (<italic>SD</italic>)</td><td char=".">3.18 (0.60)</td></tr><tr><td>CC location</td><td /></tr><tr><td> Rural area</td><td char=".">56.4%</td></tr><tr><td> Urban area</td><td char=".">43.6%</td></tr><tr><td>Year of secondary education</td><td /></tr><tr><td> First year</td><td char=".">39.0%</td></tr><tr><td> Second year</td><td char=".">50.9%</td></tr><tr><td> Other</td><td char=".">10.1%</td></tr></tbody></table> </ephtml> </p> <p>Of participants reporting NMUS, 19.3% reported being diagnosed with ADHD at some point in their life, and 23.7% reported nonmedically using their own legally obtained prescription stimulant. Among participants not reporting NMUS, 14.1% reported a lifetime diagnosis of ADHD. Half of the participants reporting NMUS indicated that a problem associated with NMUS was decreased appetite (50%), and approximately 12% of participants indicated that they were diagnosed with an eating disorder.</p> <p>Of participants reporting NMUS, 67.0% (<emph>n</emph> = 180) reported nonmedically using another substance at some point in the past year. Substances used by participants reporting NMUS include cocaine (21.9%; <emph>n</emph> = 59), "designer/club drugs" (eg ecstasy; 23.8%; <emph>n</emph> = 64), hallucinogens (31.2%; <emph>n</emph> = 84), heroin (3.7%; <emph>n</emph> = 10), inhalants (4.4%; <emph>n</emph> = 12), marijuana (66.5%; <emph>n</emph> = 179), methamphetamine (7.8%; <emph>n</emph> = 21), and steroids (5.6%; <emph>n</emph> = 15). The mode number of substances used in addition to NMUS was 1 (31.1%, <emph>n =</emph> 74), followed by no other substances (23.9%, <emph>n =</emph> 57), and 2 other substances (15.5%, <emph>n</emph> = 37).</p> <p>Participants reported using the following ROAs for NMUS in the past year: by mouth (95.9%), snorting (17.0%), and smoking (5.1%). Participants reported the following frequency of NMUS over the past 12 months: only once (25.2%), less than monthly (49.0%), monthly but not weekly (16.4%), and at least once per week (9.4%).</p> <hd id="AN0181109515-12">Motives for NMUS</hd> <p>The most frequently reported motive for NMUS was to focus on studies or improve academic performance, which 67.5% of participants endorsed. Other motives for NMUS included to have more energy (52.4%), to relax or relieve tension (23.4%), to lose weight (17.8%), to feel good or get high (17.5%), to experiment (15.7%), to improve athletic performance (3.8%), and due to peer pressure (3.1%). The most frequent number of distinct motives selected was five.</p> <hd id="AN0181109515-13">Gender and motives for NMUS</hd> <p>Participants reporting "to experiment" as a motive for NMUS were more likely to be males χ<sups>2</sups> (<reflink idref="bib1" id="ref44">1</reflink>, _I_N_i_ = 284) = 5.59, <emph>p</emph> =.01. and participants reporting "to lose weight" as a motive for NMUS were more likely to be females χ<sups>2</sups> (<reflink idref="bib1" id="ref45">1</reflink>, _I_N_i_ = 284) = 7.92, <emph>p</emph> <.01. See Table 2 for statistics. Chi-square tests of independence found that gender did not differ in relation to the following motives for NMUS: due to peer pressure, to feel good or get high, to focus on studies or to improve academic performance, to have more energy, to improve athletic performance, or to relax or relieve tension.</p> <p>Table 2. Chi-square statistics examining gender and motives for NMUS.</p> <p> <ephtml> <table><thead><tr><td /><td /><td>Gender</td><td /></tr><tr><td /><td /><td>% Male</td><td>% Female</td><td /></tr></thead><tbody valign="top"><tr><td>Due to peer pressure</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 252) = 0.05</td></tr><tr><td /><td>Yes</td><td char=".">2.5</td><td char=".">2.9</td><td /></tr><tr><td /><td>No</td><td char=".">97.5</td><td char=".">97.1</td><td /></tr><tr><td>To experiment</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 252) = 5.59***</td></tr><tr><td /><td>Yes</td><td char=".">22.8</td><td char=".">11.9</td><td /></tr><tr><td /><td>No</td><td char=".">77.2</td><td char=".">88.0</td><td /></tr><tr><td>To feel good or get high</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 252) = 2.75</td></tr><tr><td /><td>Yes</td><td char=".">23.2</td><td char=".">14.7</td><td /></tr><tr><td /><td>No</td><td char=".">76.8</td><td char=".">85.3</td><td /></tr><tr><td>To improve academic performance</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 252) = 0.83</td></tr><tr><td /><td>Yes</td><td char=".">74.3</td><td char=".">68.8</td><td /></tr><tr><td /><td>No</td><td char=".">25.7</td><td char=".">31.2</td><td /></tr><tr><td>To have more energy</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 252) = 1.99</td></tr><tr><td /><td>Yes</td><td char=".">48.8</td><td char=".">58.2</td><td /></tr><tr><td /><td>No</td><td char=".">51.2</td><td char=".">41.8</td><td /></tr><tr><td>To improve athletic performance</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 252) = 3.38</td></tr><tr><td /><td>Yes</td><td char=".">6.1</td><td char=".">1.8</td><td /></tr><tr><td /><td>No</td><td char=".">93.9</td><td char=".">98.2</td><td /></tr><tr><td>To lose weight</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 252) = 7.924***</td></tr><tr><td /><td>Yes</td><td char=".">8.7</td><td char=".">22.4</td><td /></tr><tr><td /><td>No</td><td char=".">91.3</td><td char=".">77.6</td><td /></tr><tr><td>To relax or relieve tension</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 252) = 0.219</td></tr><tr><td /><td>Yes</td><td char=".">23.1</td><td char=".">20.5</td><td /></tr><tr><td /><td>No</td><td char=".">76.9</td><td char=".">79.5</td><td /></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note. ***p <.001.</emph></p> <hd id="AN0181109515-14">Rurality and motives for NMUS</hd> <p>Chi-square tests of independence found that no motives for NMUS differed based on attending school in an urban or rural setting.</p> <hd id="AN0181109515-15">Age and motives for NMUS</hd> <p>Results of Welch's <emph>t</emph>-tests found that age did not differ between individuals who endorsed and denied the following motives for NMUS: due to peer pressure, to have more energy, to improve athletic performance, to lose weight, or to relax or relieve tension. Participants engaging in NMUS to experiment, feel good or get high, or focus on studies or improve academic performance were significantly younger than participants who did not endorse those reasons for NMUS. See Table 3 for statistics.</p> <p>Table 3. <emph>T</emph>-test statistics examining age and motives for NMUS (<emph>N</emph> = 269).</p> <p> <ephtml> <table><thead><tr><td /><td /><td>Age</td><td /></tr><tr><td /><td /><td>Mean</td><td><italic>SD</italic></td><td /></tr></thead><tbody valign="top"><tr><td>Due to peer pressure</td><td /><td /><td><italic>t</italic>(1) = 1.95</td></tr><tr><td /><td>Yes</td><td char=".">19.0</td><td char=".">1.2</td><td /></tr><tr><td /><td>No</td><td char=".">24.9</td><td char=".">8.1</td><td /></tr><tr><td>To experiment</td><td /><td /><td><italic>t</italic>(1) = 15.07***</td></tr><tr><td /><td>Yes</td><td char=".">21.8</td><td char=".">5.6</td><td /></tr><tr><td /><td>No</td><td char=".">25.7</td><td char=".">8.7</td><td /></tr><tr><td>To feel good or get high</td><td /><td /><td><italic>t</italic>(1) = 6.34**</td></tr><tr><td /><td>Yes</td><td char=".">22.9</td><td char=".">6.5</td><td /></tr><tr><td /><td>No</td><td char=".">25.6</td><td char=".">8.7</td><td /></tr><tr><td>To improve academic performance</td><td /><td /><td><italic>t</italic>(1) = 9.25**</td></tr><tr><td /><td>Yes</td><td char=".">23.9</td><td char=".">6.5</td><td /></tr><tr><td /><td>No</td><td char=".">27.6</td><td char=".">10.9</td><td /></tr><tr><td>To have more energy</td><td /><td /><td><italic>t</italic>(1) = 1.43</td></tr><tr><td /><td>Yes</td><td char=".">25.5</td><td char=".">8.1</td><td /></tr><tr><td /><td>No</td><td char=".">24.0</td><td char=".">7.9</td><td /></tr><tr><td>To improve athletic performance</td><td /><td /><td><italic>t</italic>(1) = 0.97</td></tr><tr><td /><td>Yes</td><td char=".">22.1</td><td char=".">3.9</td><td /></tr><tr><td /><td>No</td><td char=".">24.9</td><td char=".">8.1</td><td /></tr><tr><td>To lose weight</td><td /><td /><td><italic>t</italic>(1) =1.85</td></tr><tr><td /><td>Yes</td><td char=".">26.9</td><td char=".">9.43</td><td /></tr><tr><td /><td>No</td><td char=".">24.4</td><td char=".">7.7</td><td /></tr><tr><td>To relax or relieve tension</td><td /><td /><td><italic>t</italic>(1) = 1.71</td></tr><tr><td /><td>Yes</td><td char=".">23.2</td><td char=".">8.1</td><td /></tr><tr><td /><td>No</td><td char=".">25.2</td><td char=".">7.9</td><td /></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note. **p <.01, ***p <.001</emph>.</p> <hd id="AN0181109515-16">Risky behaviors and motives for NMUS</hd> <p>Participants who endorsed the following motives were more likely to administer prescription stimulants non-orally than participants without these motives: "to feel good or get high" [χ<sups>2</sups> (<reflink idref="bib1" id="ref46">1</reflink>, _I_N_i_ = 285) = 59.90, <emph>p</emph> <.001]; "to experiment" [χ<sups>2</sups> (<reflink idref="bib1" id="ref47">1</reflink>, _I_N_i_ = 285) = 13.15, <emph>p</emph> =.001]; "to have more energy" [χ<sups>2</sups> (<reflink idref="bib1" id="ref48">1</reflink>, _I_N_i_ = 285) = 7.26, <emph>p</emph> <.01]; and "to relax or relive tension" [χ<sups>2</sups> (<reflink idref="bib1" id="ref49">1</reflink>, _I_N_i_ = 285) = 10.18, <emph>p</emph> <.01]. See Table 4 for statistics.</p> <p>Table 4. Chi-square statistics examining route of administration and motives for NMUS.</p> <p> <ephtml> <table><thead><tr><td /><td /><td>Non-oral ROA</td><td /></tr><tr><td /><td /><td>% Yes</td><td>% No</td><td /></tr></thead><tbody valign="top"><tr><td>Due to peer pressure</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 252) = 0.15</td></tr><tr><td /><td>Yes</td><td char=".">3.5</td><td char=".">96.5</td><td /></tr><tr><td /><td>No</td><td char=".">2.6</td><td char=".">97.4</td><td /></tr><tr><td>To experiment</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 285) = 13.15***</td></tr><tr><td /><td>Yes</td><td> 88.3</td><td> 69.4</td><td /></tr><tr><td /><td>No</td><td> 11.7</td><td> 30.6</td><td /></tr><tr><td>To feel good or get high</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 285) = 59.90***</td></tr><tr><td /><td>Yes</td><td> 80.7</td><td> 61.3</td><td /></tr><tr><td /><td>No</td><td> 19.3</td><td> 38.7</td><td /></tr><tr><td>To improve academic performance</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 252) = 2.39</td></tr><tr><td /><td>Yes</td><td char=".">78.9</td><td char=".">21.1</td><td /></tr><tr><td /><td>No</td><td char=".">68.4</td><td char=".">31.6</td><td /></tr><tr><td>To have more energy</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 285) = 7.26**</td></tr><tr><td /><td>Yes</td><td> 91.9</td><td> 50.0</td><td /></tr><tr><td /><td>No</td><td> 8.1</td><td> 50.0</td><td /></tr><tr><td>To improve athletic performance</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 252) = 0.03</td></tr><tr><td /><td>Yes</td><td char=".">3.5</td><td char=".">96.5</td><td /></tr><tr><td /><td>No</td><td char=".">3.1</td><td char=".">96.9</td><td /></tr><tr><td>To lose weight</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 252) = 0.05</td></tr><tr><td /><td>Yes</td><td char=".">17.5</td><td char=".">82.5</td><td /></tr><tr><td /><td>No</td><td char=".">16.3</td><td char=".">83.7</td><td /></tr><tr><td>To relax or relieve tension</td><td /><td /><td>χ<sup>2</sup> (1, <italic>N</italic> = 285) = 10.18**</td></tr><tr><td /><td>Yes</td><td> 51.6</td><td> 32.3</td><td /></tr><tr><td /><td>No</td><td> 48.4</td><td> 67.7</td><td /></tr></tbody></table> </ephtml> </p> <p>3 <emph>Note. **p <.01, ***p <.001</emph>.</p> <p>Welch's <emph>t</emph>-tests found that participants reporting the motive "to feel good or get high" used more substances nonmedically [(<emph>M</emph> = 3.02; <emph>SD</emph> = 2.15; <emph>M</emph> = 1.54; <emph>SD</emph> = 1.58), <emph>t</emph>(<reflink idref="bib260" id="ref50">260</reflink>)= −5.27, <emph>p</emph> <.001] than participants who did not report this motive. No other motives were significantly related to the number of substances used nonmedically.</p> <p>Results from the ANOVA demonstrate that the number of motives for NMUS differed between participants reporting different frequencies of NMUS. Sex (male = reference category) was included as a covariate in this model. The overall model was significant, <emph>F</emph>(<reflink idref="bib3" id="ref51">3</reflink>, 272) = 3.86, <emph>p</emph> =.01. The Games–Howell <emph>post hoc</emph> revealed subgroup differences. Specifically, participants with at least weekly NMUS reported greater number of motives for NMUS as compared to participants reporting one instance of NMUS in the past 12 months. Similarly, participants with at least weekly NMUS reported greater number of motives for NMUS participants reporting one instance of NMUS in the past 12 months. See Table 5 for mean number of motives compared to the frequency of NMUS.</p> <p>Table 5. Mean number of motives for NMUS by frequency of NMUS (<emph>N</emph> = 269).</p> <p> <ephtml> <table><thead><tr><td>Frequency</td><td>Mean number of motives</td></tr></thead><tbody valign="top"><tr><td>Once</td><td char=".">5.36</td></tr><tr><td>Less than monthly</td><td char=".">5.75</td></tr><tr><td>Monthly but not weekly</td><td char=".">6.19</td></tr><tr><td>At least weekly</td><td char=".">6.56</td></tr></tbody></table> </ephtml> </p> <p>A binary logistic regression was calculated to examine the effect of the number of motives on the likelihood that participants would administer stimulants non-orally. The model was first run controlling for the significant covariate gender and the motive "to feel good or get high." Since gender was not significant in this model, it was removed, and the model was re-analyzed. The logistic regression model was statistically significant (χ<sups>2</sups>(<reflink idref="bib1" id="ref52">1</reflink>) = 6.43, <emph>p</emph> =.01). The model explained 35.0% (Nagelkerke <emph>R</emph><sups>2</sups>) of the variance and correctly classified 77.8% of cases. Higher number of motives was associated with an increased likelihood of using a non-oral ROA, OR = 1.33, (95% CI = 1.1, 1.5).</p> <hd id="AN0181109515-17">Discussion</hd> <p>Results from these analyses of survey data collected from a large sample of CC students suggest patterns of NMUS behavior engagement and motives not unlike those of students attending 4-year universities. NMUS was reported by 9% of CC students, which is comparable to estimates of NMUS among 4-year university students.[[<reflink idref="bib3" id="ref53">3</reflink>], [<reflink idref="bib5" id="ref54">5</reflink>]] The relatively high rates of co-occurring substance use among participants reporting NMUS (67%) align with prior research establishing an association between NMUS and other risky health behaviors.[<reflink idref="bib5" id="ref55">5</reflink>]</p> <p>Higher rates of ADHD diagnoses were reported by participants reporting NMUS compared to rates among participants not reporting NMUS. This finding is congruent with past research identifying associations between ADHD symptoms and elevated risk of nonmedical substance use.[<reflink idref="bib5" id="ref56">5</reflink>],[<reflink idref="bib31" id="ref57">31</reflink>] Notably, 23.7% of CC students with ADHD reported nonmedically using their own legally obtained prescription stimulant, which is comparable to estimates of this behavior among 4-year university students (26.7%).[<reflink idref="bib32" id="ref58">32</reflink>] Stimulants are known to suppress appetite, which may relate to the elevated rate of disordered eating among these participants. The relation between the symptoms associated with ADHD, disordered eating, and NMUS among CC students is reported for the first time here and may benefit from future longitudinal examination.</p> <p>Comparable to examinations of NMUS among 4-year university students, the most common motives for NMUS were to focus on studies/improve academic performance and to increase energy.[<reflink idref="bib33" id="ref59">33</reflink>] Despite the common belief that NMUS will enhance academic performance, NMUS has been associated with numerous negative academic outcomes, including lower academic performance, low attrition rates, and higher probabilities of facing unemployment upon graduation.[<reflink idref="bib34" id="ref60">34</reflink>] It is possible that dissemination of information among CC students regarding the inefficacy of NMUS to improve academic performance may prevent their initiation of NMUS, which should be evaluated empirically in future research.</p> <p>Another common motive for NMUS observed in this sample was to relax or relieve tension. This motivation appears paradoxical due to the heightening of alertness and attention caused by prescription stimulants. However, prior research has found this motive to be linked with the desire to alleviate psychological distress.[<reflink idref="bib8" id="ref61">8</reflink>],[<reflink idref="bib35" id="ref62">35</reflink>] Given the high rate of mental health diagnoses among participants reporting NMUS,[<reflink idref="bib32" id="ref63">32</reflink>] it is plausible that self-medication underlies this motive. These findings highlight the need for more accessible healthcare services for CC students (eg health insurance, CC counseling centers).[<reflink idref="bib24" id="ref64">24</reflink>]</p> <p>Weight loss was cited as a motive by 8.69% of males and 22.39% of females engaging in NMUS. This gender difference is unsurprising given the elevated rates of dieting, weight concerns, and disordered eating among females compared to males.[<reflink idref="bib36" id="ref65">36</reflink>] Since NMUS for weight loss is associated with disordered eating, low self-esteem, depression, and anxiety, this finding highlights the need for appropriate identification and treatment of eating disorders among females CC students.[<reflink idref="bib17" id="ref66">17</reflink>],[<reflink idref="bib37" id="ref67">37</reflink>],[<reflink idref="bib38" id="ref68">38</reflink>]</p> <p>Several motives were linked to riskier forms of NMUS. Specifically, "to feel good or get high" was associated with polysubstance use and non-oral administration of the stimulant. "To experiment," "to have more energy," and "to relax or relieve tension" were associated with non-oral ROAs. These motives span dimensions of internal (eg to feel good), external (eg performance enhancement), positive reinforcement (eg to get high), and negative reinforcement (to relieve tension). Although research suggests that non-oral ROAs are riskier,[<reflink idref="bib5" id="ref69">5</reflink>] it is unknown whether students are aware of the added danger. It is possible that providing psychoeducation on the risks of non-oral ROAs to CC students may be a first step toward reducing adverse health outcomes of NMUS. Understanding students' motives for NMUS makes it plausible to identify students at risk of non-oral ROAs and who might benefit from psychoeducation. Ultimately, reducing NMUS via non-oral ROAs may be a meaningful method of harm reduction among CC students, and thereby warrants future attention.</p> <p>Notably, participants were not limited in how many motives they could report. Participants endorsing more motives were found to be more likely to report using a non-oral ROA. Additionally, participants who endorsed a higher number of motives for NMUS tended to report more frequent NMUS. This finding is consistent with recent research findings that multiple motives for substance use are associated with higher symptomatology and riskier forms of use.[<reflink idref="bib8" id="ref70">8</reflink>] The preponderance of motives for NMUS that are not related to demographic variables provides evidence that certain motives (eg to enhance academic performance) are consistent regardless of psychosocial characteristics. However, as these findings were exploratory and therefore not rooted in specific hypotheses, they should be interpreted with caution until they are replicated among CC students in other parts of the US.</p> <p>Targeting specific, common motives of NMUS may enhance the efficacy of behavioral strategies embedded in cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for NMUS-related concerns.[<reflink idref="bib39" id="ref71">39</reflink>],[<reflink idref="bib40" id="ref72">40</reflink>] Specifically, CBT-based cognitive restructuring may be used to promote a balanced view of the self and the importance of academic achievements.[<reflink idref="bib41" id="ref73">41</reflink>],[<reflink idref="bib42" id="ref74">42</reflink>] Psychoeducation on study strategies derived from cognitive psychology may improve academic performance.[<reflink idref="bib43" id="ref75">43</reflink>] Increased energy may be achieved through CBT-based behavioral activation, and individuals who are fatigued due to some sleep disorders may benefit from CBT for insomnia (CBTi).[<reflink idref="bib44" id="ref76">44</reflink>] Relaxation and tension release may be cultivated through increased mindfulness and present-moment awareness, a core feature of ACT.[<reflink idref="bib39" id="ref77">39</reflink>] Anchoring prevention and intervention of NMUS in motives may offer adaptive strategies for meeting the same targets while reducing the potential for harm from NMUS. Importantly, most participants reported multiple motives for NMUS, and it may be helpful to target multiple motives or patterns of motives rather than individual motives. Future research examining the benefit of tailoring treatment based on single motives or clusters of motives is warranted.</p> <p>Despite the potential benefits of psychotherapy on NMUS-related concerns for CC students, CCs tend to offer fewer mental health and counseling services compared to traditional 4-year institutions.[<reflink idref="bib45" id="ref78">45</reflink>] There may be additional barriers to accessing on-campus services for CC students compared to 4-year university students due to time limitations, cost constraints, and competing obligations such as work.[<reflink idref="bib45" id="ref79">45</reflink>] These challenges highlight the importance of increasing funding investments and accessibility of mental health services among CCs.</p> <hd id="AN0181109515-18">Limitations</hd> <p>Rates of NMUS were established using self-report data which is subject to biased recall, memory bias, and underreporting. Responses were anonymous and not identifiable to help mitigate the impact of underreporting. However, future research utilizing longitudinal observations of NMUS or ecological momentary assessments may provide more precise estimations of NMUS. Another limitation of the present study is potential response bias. Approximately 54,000 students received a request to participate in the study, but just over 3,000 students responded. The impact of response bias on the current study results is unknown. Additionally, the sample did not reflect the overall demographic makeup of community colleges. Approximately 70% of participants were females and all participants lived in the southeastern region of the US. Future research should advance upon the present study by collecting data from a nationally representative sample, thereby increasing the generalizability of findings.</p> <hd id="AN0181109515-19">Conclusions</hd> <p>The present study examined the motives for NMUS reported by CC students. The most common motive for NMUS was to "focus on studies or to improve academic performance" and to "have more energy." Motives were associated with demographic characteristics (ie gender, age) and behaviors associated with NMUS (ie polysubstance use). CC students report similar motives for NMUS as commonly endorsed by 4-year university students. These findings support the need for future research to evaluate motive-linked prevention and treatment of NMUS.</p> <hd id="AN0181109515-20">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. 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  Label: Title
  Group: Ti
  Data: Motives for Nonmedical Use of Prescription Stimulants in Community College Students
– Name: Language
  Label: Language
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  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Hannah+G%2E+Mitchell%22">Hannah G. Mitchell</searchLink><br /><searchLink fieldCode="AR" term="%22Shelby+A%2E+King%22">Shelby A. King</searchLink><br /><searchLink fieldCode="AR" term="%22Meredith+K%2E+Ginley%22">Meredith K. Ginley</searchLink><br /><searchLink fieldCode="AR" term="%22Kelly+N%2E+Foster%22">Kelly N. Foster</searchLink><br /><searchLink fieldCode="AR" term="%22Nicholas+E%2E+Hagemeier%22">Nicholas E. Hagemeier</searchLink><br /><searchLink fieldCode="AR" term="%22Rajkumar+J%2E+Sevak%22">Rajkumar J. Sevak</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4354-5054">0000-0003-4354-5054</externalLink>)
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  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2024 72(9):3556-3563.
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  Label: Availability
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  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 8
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Two+Year+Colleges%22">Two Year Colleges</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Drug+Abuse%22">Drug Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Stimulants%22">Stimulants</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Motivation%22">Student Motivation</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Community+College+Students%22">Community College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Characteristics%22">Student Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Rural+Urban+Differences%22">Rural Urban Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Age+Differences%22">Age Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Behavior%22">Health Behavior</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2023.2180997
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: The present study identified common motives for nonmedical use of prescription stimulants (NMUS) among community college (CC) students and examined behavioral and demographic correlates of certain motives. Participants: The survey was completed by 3,113 CC students (72.4% female; 81.7% White). Methods: Survey results from 10 CCs were evaluated. Results: NMUS was reported by 9% (n = 269) participants. The most common motive for NMUS was to "focus on studies or to improve academic performance" (67.5%) followed by to "have more energy" (52.4%). Females were more likely to report NMUS for weight loss, and males were more likely to report NMUS to experiment. The motive "to feel good or get high" was linked to polysubstance use. Conclusions: CC students report similar motives for NMUS to those commonly endorsed by 4-year university students. These findings may help identify CC students susceptible to risky substance use.
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  Label: Entry Date
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  Data: 2024
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  Label: Accession Number
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  Data: EJ1452238
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      – Text: English
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      Pagination:
        PageCount: 8
        StartPage: 3556
    Subjects:
      – SubjectFull: Drug Abuse
        Type: general
      – SubjectFull: Stimulants
        Type: general
      – SubjectFull: Student Motivation
        Type: general
      – SubjectFull: Gender Differences
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      – SubjectFull: Community College Students
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      – SubjectFull: Rural Urban Differences
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      – SubjectFull: Health Behavior
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      – TitleFull: Motives for Nonmedical Use of Prescription Stimulants in Community College Students
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