ECPN Student Poster Contestant: Risk Factors for Adolescent Opioid Misuse in Washington State

Introduction: Despite the increasing misuse of opioids by adolescents, there is a dearth of prevention programs targeting adolescent opioid misuse. An alternative to opioid-specific prevention programming is to select programs targeting risk factors that are likely to affect opioid use. Thus, we have identified salient, malleable risk factors relating to adolescent opioid misuse to inform policy decisions regarding prevention efforts and to facilitate program selection.

Method: The sample consisted of 27,879 grade 10 students who completed Form A of Healthy Youth Survey (HYS) in 2016. HYS is a self-reported measure administered every two years to middle and high school students in Washington State. The outcomes of interest were any misuse of painkillers in past 30 days and any heroin use ever. We conducted a literature review to identify risk factors associated with adolescent opioid misuse. Results of the literature review revealed risk factors in all four domains: peer-individual, family, school, and community. We cross-walked these factors with variables from the 2016 HYS to identify variables to be included in our statistical model. This process resulted in the identification of four demographic factors (gender, race/ethnicity, mother’s education status, and geographic location), and 13 malleable risk factors. We conducted hierarchical generalized linear modeling (HGLM) using Proc Glimmix in SAS 9.4 to account for clustered nature of data and binary nature of the outcome variables. Result of deviance test indicated that the model with student-level risk factors and covariates had the best model fit.

Results: Out of 26,100 students who responded to question regarding any misuse of painkillers in past 30 days, 1,235 (4.7%) reported painkiller misuse. Out of 25,720 students who responded to question regarding any heroin use ever, 866 (3.4%) reported heroin use. A total of 328 students reported both painkiller misuse and heroin use. Results indicated that nine risk factors across peer-individual, family, and community domains were statistically associated with painkiller misuse and seven factors with heroin use at p<.05, after controlling for the effects of demographics and other risk factors. Six risk factors were significantly associated with both painkiller misuse and heroin use: past 30-day cigarette smoking, past 30-day drunkenness, past 30-day other substance use, age of first use, perceived risk of drug use, and low opportunities for prosocial involvement in community.

Conclusion: Policy makers and program providers can use these results to identify and prioritize risk factors associated with adolescent opioid misuse to select and deliver much needed prevention programming.