Drug use patterns in young adulthood and post-college employment.

BACKGROUND: The relationship between serious drug involvement and risk for unemployment is well recognized, but few studies have prospectively examined this relationship among college students. This study used longitudinal data to examine the association between drug use patterns during college and the likelihood of employment post-college, holding constant sociodemographic variables and personality characteristics. Second, we estimate the prevalence of alcohol and other drug use disorders among employed individuals. METHODS: Data were derived from the College Life Study. Participants entered college as traditional students and were assessed annually for six years, regardless of continued college attendance. Analyses were restricted to 620 individuals no longer enrolled in school by Year 6. RESULTS: Using multinomial regression modeling, persistent drug users (i.e., used illicit drugs (other than marijuana) and/or nonmedical prescription drugs every year they were assessed during the first four years of study) were significantly more likely than non-users to be unemployed vs. employed full-time post-college. Persistent drug users and infrequent marijuana users were also more likely than non-users to be unemployed vs. employed part-time. In Year 6, 13.2% of individuals employed full-time and 23.7% of individuals employed part-time met DSM-IV criteria for drug abuse or dependence during the past year. CONCLUSIONS: If confirmed, the results of this study suggest that persistent drug use among academically achieving young adults might increase risk for post-college unemployment. More research is needed to understand the processes underlying this association. Further attention should be directed at managing substance use problems among recent college graduates who have secured employment.

Dispelling the myth of "smart drugs": cannabis and alcohol use problems predict nonmedical use of prescription stimulants for studying.

This study tested the hypothesis that college students' substance use problems would predict increases in skipping classes and declining academic performance, and that nonmedical use of prescription stimulants (NPS) for studying would occur in association with this decline. A cohort of 984 students in the College Life Study at a large public university in the US participated in a longitudinal prospective study. Interviewers assessed NPS; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) cannabis and alcohol use disorders; and frequency of skipping class. Semester grade point average (GPA) was obtained from the university. Control variables were race, sex, family income, high school GPA, and self-reported attention deficit hyperactivity disorder diagnosis. Longitudinal growth curve modeling of four annual data waves estimated the associations among the rates of change of cannabis use disorder, percentage of classes skipped, and semester GPA. The associations between these trajectories and NPS for studying were then evaluated. A second structural model substituted alcohol use disorder for cannabis use disorder. More than one-third (38%) reported NPS for studying at least once by Year 4. Increases in skipping class were associated with both alcohol and cannabis use disorder, which were associated with declining GPA. The hypothesized relationships between these trajectories and NPS for studying were confirmed. These longitudinal findings suggest that escalation of substance use problems during college is related to increases in skipping class and to declining academic performance. NPS for studying is associated with academic difficulties. Although additional research is needed to investigate causal pathways, these results suggest that nonmedical users of prescription stimulants could benefit from a comprehensive drug and alcohol assessment to possibly mitigate future academic declines.

Drug use patterns and continuous enrollment in college: results from a longitudinal study.

OBJECTIVE: Few longitudinal studies have examined the relationship between illicit drug use and academic outcomes among college students. This study characterized drug use patterns of a cohort of young adults who were originally enrolled as first-time, first-year college students in a longitudinal study. It evaluated the association between these drug use patterns and continuous enrollment during college, holding constant demographic characteristics, high school grade point average, fraternity/sorority involvement, personality/temperament characteristics, nicotine dependence, and alcohol use disorder. METHOD: Participants (n = 1,133; 47% male) were purposively selected from one university and interviewed annually for 4 years, beginning with their first year of college, regardless of continued college attendance. Enrollment data were culled from administrative records. Group-based trajectory analyses characterized 4-year longitudinal drug use patterns. Two grouping variables were derived based on (a) marijuana use frequency and (b) number of illicit drugs used other than marijuana. Seventy-one percent of the sample was continuously enrolled in the home institution during the first 4 years of study. RESULTS: Multivariable logistic regression models demonstrated that infrequent, increasing, and chronic/heavy marijuana use patterns were significantly associated with discontinuous enrollment (adjusted odds ratio = 1.66, 1.74, and 1.99, respectively), compared with minimal use, holding constant covariates. In separate models, drug use other than marijuana also was significantly associated with discontinuous enrollment. CONCLUSIONS: Marijuana use and other illicit drug use are both associated with a decreased likelihood of continuous enrollment in college, independent of several other possible risk factors. These findings highlight the need for early intervention with illicit drug users to mitigate possible negative academic consequences.

Cigarette smoking among college students: longitudinal trajectories and health outcomes.

INTRODUCTION: Light and intermittent patterns of cigarette smoking are prevalent among U.S. college-aged individuals. It is unclear whether intermittent smokers maintain their use over time or are transitioning to daily use or nonuse, and whether they experience more adverse health outcomes than nonsmokers. METHODS: This study examined the trajectories of tobacco cigarette smoking, their predictors, and health outcomes among students (N = 1,253) assessed during their first year of college (Y(1)) and annually thereafter (Y(2), Y(3), and Y(4)). RESULTS: In Y(1), 3.4% smoked daily and 4.1% exhibited signs of dependence (first cigarette within 30 min of waking). Growth curve modeling identified five distinct smoking trajectories. After stable nonsmokers (71.5%(wt)), the low-stable smoking trajectory was the most common (13.3%(wt)), outnumbering both low-increasing (6.5%(wt)) and high-stable smokers (5.5%(wt)) by 2:1 and high-decreasing smokers (3.2%(wt)) by 4:1. The likelihood of maintaining a low level of smoking over time was inversely related to Y(1) smoking frequency. Few demographic, smoking, and alcohol use characteristics measured in Y(1) distinguished low-increasers from low-stable smokers or high-decreasers from high-stable smokers. By Y(4), high-stable smokers rated their health significantly worse than all others except low-increasers. High-stable smokers had the most Y(4) health problems (i.e., provider visits for health problems and days of illness-related impairment), but only among nonWhites. CONCLUSIONS: Many college students smoke, but few smoke daily or are nicotine dependent. Intermittent smoking patterns are often stable throughout college and are associated with adverse health outcomes. Prevention strategies should be designed to mitigate the possible long-term health consequences of light and intermittent smoking.

Nonmedical use of prescription stimulants during college: four-year trends in exposure opportunity, use, motives, and sources.

OBJECTIVE: Examine trends in nonmedical use of prescription stimulants (NPS), including motives, routes of administration, sources, cost, and risk factors. PARTICIPANTS: 1,253 college students. METHODS: Data were collected annually during academic years 2004-2005 through 2008-2009. Generalized estimating equations analyses evaluated longitudinal trends. Logistic regression models evaluated stability of associations between risk factors and NPS over time. RESULTS: Almost two-thirds (61.8%(wt)) were offered prescription stimulants for nonmedical use by Year 4, and 31.0%(wt) used. Studying was the predominant motive (73.8% to 91.5% annually), intranasal administration was modest (< 17% annually), and the most common source was a friend with a prescription (≥ 73.9% annually). Significant changes over time included decreasing curiosity motives, increasing overuse of one's own prescription, and increasing proportion paying $5+ per pill. Lower grade point average and alcohol/cannabis use disorders were consistently associated with NPS, holding constant other factors. CONCLUSIONS: Prevention opportunities exist for parents, physicians, and college administrators to reduce NPS.

Maintaining Superior Follow-Up Rates in a Longitudinal Study: Experiences from the College Life Study.

Longitudinal studies are often considered to be a gold standard for research, but the operational management of such studies is not often discussed in detail; this paper describes strategies used to track and maintain high levels of participation in a longitudinal study involving annual personal interviews with a cohort of 1,253 undergraduates (first-time, first-year students at time of enrollment) at a large public mid-Atlantic university.

Marijuana exposure opportunity and initiation during college: parent and peer influences.

Marijuana is the most prevalent illicit drug used by adolescents and young adults, yet marijuana initiation is rarely studied past adolescence. The present study sought to advance our understanding of parent and peer influences on marijuana exposure opportunity and incident use during college. A sample of 1,253 students was assessed annually for 4 years starting with the summer prior to college entry. More than one-third (38%(wt)) of students had already used marijuana at least once prior to college entry; another 25%(wt) initiated use after starting college. Of the 360 students who did not use marijuana prior to college, 74% were offered marijuana during college; of these individuals, 54% initiated marijuana use. Both low levels of parental monitoring during the last year of high school and a high percentage of marijuana-using peers independently predicted marijuana exposure opportunity during college, holding constant demographics and other factors (AOR = 0.92, 95% CI = 0.88-0.96, p < .001 and AOR = 1.11, 95% CI = 1.08-1.14, p < .001, respectively). Among individuals with exposure opportunity, peer marijuana use (AOR = 1.04, 95% CI = 1.03-1.05, p < .001), but not parental monitoring, was associated with marijuana initiation. Results underscore that peer influences operate well into late adolescence and young adulthood and thus suggest the need for innovative peer-focused prevention strategies. Parental monitoring during high school appears to influence exposure opportunity in college; thus, parents should be encouraged to sustain rule-setting and communication about adolescent activities and friend selection throughout high school.

Help seeking and mental health service utilization among college students with a history of suicide ideation.

OBJECTIVE: This study examined help seeking among 158 college students with a lifetime history of suicide ideation. METHODS: Students were interviewed about episodes of psychological distress, formal treatment, and informal help seeking during adolescence and college. RESULTS: Of the 151 students reporting any lifetime episodes of distress, 62% experienced the first episode in adolescence, and 54% had episodes in both adolescence and young adulthood. Overall, 87% received informal help, 73% received formal treatment, and 61% received both. Among the 149 who ever sought help or treatment, the most commonly reported sources of help were family (65%), friends (54%), psychiatrists (38%), and psychologists (33%). Of the 94 individuals who experienced suicide ideation in college, 44% did not seek treatment during young adulthood. Treatment barriers reflected ambivalence about treatment need or effectiveness, stigma, and financial concerns. CONCLUSIONS: Most students had some contact with treatment, but family and friends might be important gatekeepers for facilitating treatment access.

Prescription analgesic use among young adults: adherence to physician instructions and diversion.

OBJECTIVES: To understand the extent to which medication adherence was related to diversion of prescription analgesics. DESIGN: Cross-sectional analyses of data from the College Life Study, a prospective study of young adults. SETTING: Participants were originally sampled as incoming first-time first-year college students from one large public university in the Mid-Atlantic United States. PARTICIPANTS: One hundred ninety-two young adults aged 21-26 who were prescribed an analgesic to treat acute pain in the past year. OUTCOME MEASURE: Diversion of prescription analgesics. The study tested two competing hypotheses: 1) individuals who skip doses (under-users) are at greatest risk for diversion because they have leftover medication; and 2) individuals who over-use their prescriptions (over-users) are at greatest risk for diversion, perhaps because of a general propensity to engage in deviant behavior. RESULTS: Fifty-eight percent followed physician's instructions regarding their prescription analgesic medication; 27% under-used their prescribed medication and 16% over-used their prescribed medication. Twenty-seven percent of the total sample diverted their medication, with over-users being the most likely to divert (63%). Holding constant demographic characteristics and perceived harmfulness of nonmedical use, over-users were almost five times as likely as adherent users to divert analgesic medications (P < 0.05). CONCLUSIONS: Further research is needed to better understand the relationship between adherence and diversion. If these findings are replicated, physicians who are involved in pain management for acute conditions among young adults should take steps to monitor adherence and reduce diversion of prescription analgesics.

Substance-related traffic-risk behaviors among college students.

AIMS: Drunk driving is a major public health concern, but drugged driving has received little attention. This study examines drugged driving and riding with a drugged driver in a college student sample, in terms of prevalence, age-related trends, race/sex differences, overlap with drunk driving, and risk for alcohol and marijuana dependence. METHODS: Students (N=1194) ages 19-22 were interviewed annually for 3 years about past-year frequency of drugged driving, riding with a drugged/drunk driver, drunk driving, access to a car, and alcohol/drug dependence. Annual follow-up rates were excellent (88-91%). Repeated measures analyses were conducted using generalized estimating equations (GEE). RESULTS: One in six (17%(wt)) 19-year-olds with access to a car drove drugged in the past year; prevalence remained stable through age 22. Drugged driving was more prevalent among males (p<.001) and whites (p<.01). Riding with a drugged driver varied by race and sex (overall prevalence 28%(wt) at age 19), was stable from age 19 to 21, and decreased by age 22 (p<.05). Annually, half of drugged drivers also drove drunk (ranges between 47% and 60%). Both drugged and drunk driving were independently associated with increased risk for alcohol dependence, holding constant age, sex, and race. Drunk driving did not add to the risk for marijuana dependence in the context of drugged driving. CONCLUSIONS: The prevalence of drugged driving is similar to drunk driving among college students. Both are strongly associated with underlying alcohol and drug dependence. Prevention and treatment implications are discussed.

College students' use of cocaine: results from a longitudinal study.

College students have high rates of heavy drinking and other risky behaviors, but little is known about trends in their use of cocaine. In this longitudinal study of 1253 college students at one large, public university in the mid-Atlantic region, annual interviews assessed opportunity to use cocaine, cocaine use, and DSM-IV criteria for cocaine abuse and dependence. Follow-up rates exceeded 87% annually. Data from the first four years of college were analyzed to detect changes over time and possible gender differences. By their fourth year of college, 36%(wt) of students had been offered cocaine at least once in their lifetime, and 13%(wt) had used cocaine. Annual prevalence of cocaine use increased significantly over time (4%(wt) in Year 1 to 10%(wt) in Year 4) and remained similar across genders. Opportunities to use cocaine were significantly more prevalent for males than females during Years 2 through 4. Cocaine use given opportunity increased significantly over time for both males and females. Among 243 cocaine users, females (n=113) had more serious use patterns than males, with higher average frequency of use (18.39 vs. 8.83 days during the peak year of use, p<.05) and greater likelihood of meeting criteria for cocaine dependence (9.3% vs. 2.5%, p<.05). Gender differences in typical cocaine dosage were not apparent. College administrators and health providers should be aware of the prevalence of cocaine use among student populations and design strategies to address the problem.

Persistent nonmedical use of prescription stimulants among college students: possible association with ADHD symptoms.

OBJECTIVE: To investigate the possible association between untreated ADHD symptoms (as measured by the Adult ADHD Self-Report Scale) and persistent nonmedical use of prescription stimulants. METHOD: Multinomial regression modeling was used to compare ADHD symptoms among three groups of college students enrolled in a longitudinal study over 4 years: (1) persistent nonmedical users of prescription stimulants, (2) persistent users of marijuana who did not use prescription stimulants nonmedically, and (3) consistent nonusers of drugs. RESULTS: ADHD symptoms were associated with being a persistent nonmedical user of prescription stimulants after adjustment for race/ethnicity, sex, socioeconomic status, and other illicit drug use. No associations were observed between ADHD symptoms and being a persistent marijuana user or nonuser. CONCLUSION: ADHD symptoms, and in particular inattention symptoms, appeared to be associated with nonmedical use of prescription stimulants.

Self-reported adult attention-deficit/hyperactivity disorder symptoms among college students.

OBJECTIVE: Report the distribution of scores from the Adult ADHD Self-Report Scale (ASRS) and estimate the prevalence of self-reported attention-deficit/hyperactivity disorder (ADHD) symptoms as compared to clinical diagnoses. PARTICIPANTS: Participants were 1,080 college students, divided into 3 groups: (1) no ADHD diagnosis (n = 972), (2) diagnosed with ADHD but no current pharmacologic treatment (n = 54), and (3) diagnosed with ADHD with current pharmacologic treatment (n = 54). METHODS: The ASRS was administered during the fourth annual interview of an ongoing longitudinal cohort study. RESULTS: As expected, individuals who were never clinically diagnosed with ADHD had lower ASRS scores (M = 4.0, SD = 3.3) than individuals diagnosed with ADHD who were either under current pharmacologic treatment (M = 7.9, SD = 4.0) or not under treatment (M = 6.3, SD = 3.7). Overall, 10.3%wt of individuals without an existing clinical diagnosis of ADHD had high levels of ADHD symptoms. CONCLUSIONS: A substantial minority of undiagnosed individuals may benefit from a clinical assessment for ADHD.