Predicting students' intention to use stimulants for academic performance enhancement

Modeling college EFL teachers' intentions to conduct academic research: Integrating theory of planned behavior with self-determination theory

This study constructed a robust theoretical model aimed at elucidating the determinants that shape college EFL teachers' research intentions by integrating the tenets of Self-Determination Theory (SDT) with Theory of Planned Behavior (TPB). This model was empirically validated using data from 271 EFL teachers from eight colleges in China, selected through stratified sampling and collected via paper questionnaires, then analyzed using structural equation modeling. The findings underscore the instrumental roles of both autonomous and controlled motivations in driving research-related behaviors, thereby reinforcing the foundational concepts of SDT. Additionally, this study provides intricate insights into the mechanisms wherein motivation steers immediate determinants of research intention, encompassing attitudes, subjective norms, and perceived behavioral control. This melding of SDT and TPB offers an all-encompassing perspective on the multifaceted nexus between motivation and research intentions. Consequently, this refined model not only marks a pivotal stride in advancing teacher education theory but also establishes a guiding framework for forthcoming research and interventions, accentuating the imperative of fostering research intentions among college EFL educators.

Nonmedical Use of Stimulants Among Students in Jordan: A Nationwide Study

OBJECTIVES

Nonmedical use (NMU) of stimulants is an increasingly common phenomenon worldwide. Motivated by enhancing academic performance, peer pressure, and seeking pleasure, students in the Middle East are thought to be a high-risk population. This is especially important in times when the political instability in the region facilitates the production and trafficking of such substances. This study aimed to unveil the burden of NMU of stimulants and examine associated correlates among senior high school and university students in Jordan.

METHODS

We describe a cross-sectional study of senior high school and university students in Jordan assessing NMU of stimulants. Data were collected between January and April of 2022 through a survey, which was distributed online leading to a google forms page. The survey queried sociodemographic characteristics, history of NMU of stimulants, use of other illicit substances, attitudes toward NMU of stimulants, as well as a mental health assessment.

RESULTS

A total of 8739 students completed the survey (mean age of 20.40 ± 2.45 years), of which 5.1% reported a lifetime NMU of stimulants. Fenethylline (Captagon) was the most widely reported stimulant (2.6%). Living in the southern region, being diagnosed with a personality disorder, and using concomitant illicit substances were associated with the NMU of stimulants.

CONCLUSIONS

The NMU of CNS stimulants, especially fenethylline, is prevalent in Jordan. More surveillance ought to be heeded toward the southern borders of Jordan. Students who use stimulants for academic reasons must be made aware of the potential consequences of the NMU of stimulants.

Primary prevention of prescription stimulant misuse in first-year college students

Objective: Eight percent of college students report past year prescription stimulant misuse (nonmedical use of stimulants defined as taking stimulants in a manner other than prescribed). Despite this high prevalence rate, primary prevention efforts are lacking on college campuses. Participants and Methods: A prescription stimulant misuse primary prevention intervention targeting first-year college students was developed, refined, and pilot tested. Existing substance use treatment (motivational interviewing) and time management (cognitive behavioral therapy for adult ADHD) techniques were integrated into the novel brief prevention intervention. Focus groups provided feedback to help refine the prevention intervention. Following refinements, 484 first-year college students were randomly assigned to condition (327 treatment, 157 control) and followed for 3 months. Results: Participants rated the intervention as satisfactory. After controlling for time invariant covariates, condition significantly predicted prescription stimulant misuse. There was a lower rate of past 3-month prescription stimulant misuse reported in the intervention group (4.9%) compared to the control group (11.5%). Academic expectancies remained stable in the intervention group yet increased in the control condition over time. Time management skill ratings remained stable in both groups. Changes in academic expectancies, yet not time management skills, were a partial mediator of the prevention efficacy in prescription stimulant misuse at 3-month follow-up. Conclusions: These results provide preliminary support for the acceptability and efficacy of a brief primary prevention intervention for college student prescription stimulant misuse. Changes in positive prescription stimulant expectancies, yet not time management skills, appear to be potential targets for future preventive efforts.

Factors predicting the intention of drug abuse avoidance among adolescents in Pinlaung Township, Myanmar: predictive correlational design

BACKGROUND

Adolescence is a critical transition period and is at high risk for drug/substance abuse. In Myanmar, drug use is common among adolescents and is a public health concern. There are no studies of drug abuse prevention among Myanmar adolescents. Intentions to avoid drug abuse can be a protective factor for preventing drug abuse among adolescents. This study investigated the effects of sex, parental history of drug/alcohol abuse, self-efficacy, parental marital status, and family functioning on the intention of drug abuse avoidance among Myanmar adolescents.

METHODS

This is a predictive correlational study. The Biopsychosocial model was used as the theoretical framework of this study. A convenient sampling method was used to collect data from 157 students aged 13-18 years in a government school, middle school level and high school level, Pinlaung Town, Southern Shan State, Myanmar during the COVID-19 pandemic and political protests. G* power software was used to calculate the sample size. Data was collected by four self-administered questionnaires: a socio-demographic questionnaire, Thai Family Functioning Scale (TFFS), General Self-Efficacy Scale (GSE), and Intention of Drug Avoidance Scale (IDAS). Multiple linear regression was employed to analyze the data.

RESULTS

Five predictors, including biological sex, parental history without drug/alcohol abuse, self-efficacy, parental marital status, and family functioning, explained 24.4% of the variance in the intention of drug abuse avoidance among Myanmar adolescents (R 2 = .244, F (5,151) = 9.738, p = .000). In addition, only three factors, family functioning (β = .31, p < .001), biological sex (β = -.25, p < .01), and self-efficacy (β = .16, p < .05) statistically and significantly predicted the intention of drug abuse avoidance among Myanmar adolescents.

CONCLUSIONS

Family functioning, female gender, and self-efficacy predicted the intention of drug abuse avoidance among Myanmar adolescents in Pinlaung Township, Southern Shan State, Myanmar.

IMPLICATIONS OF THIS STUDY

The results of this study have implications for all stakeholders through research, education, practice, and policymaking leading to improve the intentions of drug abuse avoidance among Myanmar adolescents. Furthermore, the results of this study specifically contribute to create psychoeducational intervention programs for increasing intention to avoid substance use by promoting family functioning and self-efficacy of adolescents. This is especially proper for male adolescents who have less intention to avoid substance use.

Academic beliefs and prescription stimulant misuse among college students: Investigating academic locus of control, grade orientation, and academic entitlement

OBJECTIVE

This study examined the relationship of students' academic beliefs to the theoretical predictors of prescription stimulant misuse outlined in the Theory of Planned Behavior.

PARTICIPANTS

Participants included 147 college students (Mage = 19.65) from a mid-sized university in the Southwestern United States.

METHOD

An online questionnaire distributed in the 10th week of the semester assessed students' academic locus of control, grade orientation, and academic entitlement in relation to their attitudes, subjective norms, perceived behavioral control, behavioral intention, and actual misuse behavior.

RESULTS

Partial correlations controlling for age, gender, and Greek life involvement indicated that academic locus of control is significantly related to all TPB variables aside from actual behavior, while grade orientation was related to perceived behavioral control and behavioral intention. Academic entitlement was not related to TPB variables in this study.

CONCLUSIONS

The associations between academic beliefs and prescription stimulant misuse hold theoretical and practical implications.

Personal, Social and Cultural Predictors of Intention to Misuse Prescription Stimulants among Medical Students: A Test of the Theory of Triadic Influence

OBJECTIVE

The misuse of prescription stimulants among students has been identified as a public health problem. To date, most research has focused on individual-level determinants of stimulant misuse, making research on the socio-cultural context of students' misuse a priority. This study aims to test the applicability of the Theory of Triadic Influence, capturing three influence streams (personal, social and cultural) and three causational levels (ultimate, distal and proximal).

METHOD

A questionnaire on stimulant misuse was distributed among all bachelor's and master's students from the five Flemish medical faculties. In total, 3159 students participated (48.99% response rate). Data were analyzed using structural equation modeling.

RESULTS

Multiple personal (i.e., fear of failure, procrastination, self-perceived ADHD, sensation-seeking, academic stress, controllability), social (i.e., living situation, peer endorsement, social norm) and cultural (i.e., competitive study-environment, financial worries, positive and negative expectancies, attitude) factors were identified as risk factors of misuse intention. The strongest ultimate to distal pathway was found between self-perceived ADHD and positive expectancies, meaning that students who believed they have ADHD, although not diagnosed, were more likely to have positive expectancies about stimulants. Moreover, the strongest distal to proximal pathways were found between expectancies and attitudes toward stimulant misuse (i.e., more positive and fewer negative expectancies were associated with more favorable attitudes). Finally, attitudes were most strongly related to misuse intention.

CONCLUSIONS

The current study shows that the TTI is an important framework to understand the risk factors of stimulant misuse among medical students. This study offers a strong basis for prevention initiatives.

Using a theoretical approach to predict college students' non-medical use of prescription drugs - a survival analysis

This study assesses students' non-medical use of prescription drugs (NMUPD) from college entrance to graduation, and examines factors that predict NMUPD. Participants: The study was conducted between May 2011 and September 2015 with 338 students. Methods: Longitudinal cohort study design was used to examine NMUPD across time, and NMUPD-related attitudes and subjective norms. Five yearly interviews were conducted to collect data. Cox proportional hazards regression analysis was used to examine time to NMUPD. Results: Thirty-five percent of study participants reported NMUPD; the majority of those initiated non-medical use before their third year in college. Analyses indicated that more positive attitudes towards NMUPD (HR = 1.73, p < 0.001), increased subjective norms regarding NMUPD (HR = 1.01, p < 0.01), and gender (male) (HR= 1.89, p < 0.001) were significantly associated with sooner NMUPD. Conclusions: Findings suggest that NMUPD prevention efforts that target mutable factors such as attitudes and subjective norms should be implemented early during students' college careers.

Towards an understanding of how stress and resources affect the nonmedical use of prescription drugs for performance enhancement among employees

Based on assumptions of the Job Demands-Resources model, we investigated employees’ willingness to use prescription drugs such as methylphenidate and modafinil for nonmedical purposes to enhance their cognitive functioning as a response to strain (i.e., perceived stress) that is induced by job demands (e.g., overtime, emotional demands, shift work, leadership responsibility). We also examined the direct and moderating effects of resources (e.g., emotional stability, social and instrumental social support) in this process. We utilized data from a representative survey of employees in Germany (N = 6454) encompassing various job demands and resources, levels of perceived stress, and willingness to use nonmedical drugs for performance enhancement purposes. By using Structural Equation Models, we found that job demands (such as overtime and emotional demands) and a scarcity of resources (such as emotional stability) increased strain, consequently directly and indirectly increasing the willingness to use prescription drugs for cognitive enhancement. Moreover, emotional stability reduced the effect of certain demands on strain. These results delivered new insights into mechanisms behind nonmedical prescription drug use that can be used to prevent such behaviour and potential negative health consequences.

Early detection of cervical cancer in western Kenya: determinants of healthcare providers performing a gynaecological examination for abnormal vaginal discharge or bleeding

BACKGROUND

In western Kenya, women often present with late-stage cervical cancer despite prior contact with the health care system. The aim of this study was to predict primary health care providers' behaviour in examining women who present with abnormal discharge or bleeding.

METHODS

This was a cross-sectional survey using the theory of planned behaviour (TPB). A sample of primary health care practitioners in western Kenya completed a 59-item questionnaire. Structural equation modelling was used to identify the determinants of providers' intention to perform a gynaecological examination. Bivariate analysis was conducted to investigate the relationship between the external variables and intention.

RESULTS

Direct measures of subjective norms (DMSN), direct measures of perceived behavioural control (DMPBC), and indirect measures of attitude predicted the intention to examine patients. Negative attitudes toward examining women had a suppressor effect on the prediction of health workers' intentions. However, the predictors of intention with the highest coefficients were the external variables being a nurse (β = 0.32) as opposed to a clinical officer and workload of attending less than 50 patients per day (β = 0.56). In bivariate analysis with intention to perform a gynaecological examination, there was no evidence that working experience, being female, having a lower workload, or being a private practitioner were associated with a higher intention to conduct vaginal examinations. Clinical officers and nurses were equally likely to examine women.

CONCLUSIONS

The TPB is a suitable theoretical basis to predict the intention to perform a gynaecological examination. Overall, the model predicted 47% of the variation in health care providers' intention to examine women who present with recurrent vaginal bleeding or discharge. Direct subjective norms (health provider's conformity with what their colleagues do or expect them to do), PBC (providers need to feel competent and confident in performing examinations in women), and negative attitudes toward conducting vaginal examination accounted for the most variance. External variables in this study also contributed to the overall variance. As the model in this study could not explain 53% of the variance, investigating other external variables that influence the intention to examine women should be undertaken.

Why Parents Misuse Prescription Drugs to Enhance the Cognitive Performance of Healthy Children: The Influence of Peers and Social Media

The mechanisms affecting parents’ misuse of prescription stimulant drugs to boost healthy children’s school performance are hardly unknown. Using four web-based factorial vignette surveys (2×2 between-subjects design experiment), we investigated the willingness of U.S. parents with school-aged children to medicate a fictitious 13-year-old child whose grades had declined. We examined mechanisms of informational and normative social influence on their decision-making: others’ behavior ( NExperiment 1 = 359), others’ definitions ( NExperiment 2 = 326), social control ( NExperiment 3 = 325), and others’ experience ( NExperiment 4 = 313). In addition, we explored the moderating role of influential sources (close friends vs. social media). Parents were more willing to engage in said behavior when others reported engagement in this behavior or positive drug experiences, especially if both influences were transmitted via social media. Others’ definitions and social control had no effect. Thus, social media might be a channel for the prevention of pharmacological cognitive enhancement.

Achievement goal orientation and stimulant misuse in college students

Objective: The prevalence of stimulant medication misuse is rising in college students. Motivations to use stimulant medications differ from motivation to use other substances such as alcohol or cannabis. However, no previous research has examined the impact of achievement goal orientation on stimulant misuse in college students. Participants: 309 college students (mean age = 18.9; 117 males) without an ADHD diagnosis were invited to participate. Methods: Participants completed an online research questionnaire that assessed factors associated with stimulant medication misuse as well as achievement goal orientations (Learning and Performance Orientations). Results: Approximately 12% endorsed a history of stimulant misuse within the past year. More males (17.1%) than females (9.4%) reported stimulant misuse. Those with and without a history of stimulant misuse differed on Performance Orientation (misuse > no misuse) yet were comparable on Learning Orientation. Conclusions: Having a higher Performance Orientation independently predicted stimulant misuse.

Mental Health, Academic Engagement, and Youths' Nonmedical Use of Stimulants: A Latent Profile Analysis

BACKGROUND:

Nonmedical prescription stimulant (NPS) use is a growing problem in Europe. Poor mental health and lack of academic engagement are potent sources of risk for substance use. Studies suggest that considerable heterogeneity may characterize the risk profiles of NPS users. To understand better the potential profiles of risk that characterize NPS users, we conducted a latent profile analysis (LPA) to document subgroups of users based on their mental health and academic engagement.

METHODS:

A nationally representative, cross sectional survey of Icelandic youth was analyzed. The sample included 584 (5% of the sample) older adolescent students participating in a national study in Iceland who reported lifetime NPS use.

RESULTS:

Three subgroups of NPS users emerged from our analyses. The largest subgroup (43.1%) we labeled mentally healthy achievers; youth who appear to be academically motivated and have few if any mental health concerns. The second largest group (40.4%), low achievers, resembled a typical profile for drug users in that they reported low or modest academic engagement and moderate levels of mental health concerns. The third group, anxious achievers (16.5%) appears to represent youth who felt academics were very important, had moderate study motivation, and also reported elevated mental health concerns, especially anxiety.

CONCLUSIONS:

LPA revealed considerable heterogeneity among these users. Group membership suggests distinct approaches to prevention to address heterogeneity in motivations for NPS use.

Students' stimulant use for cognitive enhancement: A deliberate choice rather than an emotional response to a given situation

BACKGROUND

Prescription stimulants such as methylphenidate are usually prescribed to treat attention deficit (and hyperactivity) disorders (ADHD). Recently, these drugs have gained popularity among college students, because of the belief that they can help improve academic performance.

OBJECTIVES

This study assessed whether engaging in nonmedical use of prescription stimulants for cognitive enhancement is a rational or a more spontaneous decision-making process.

METHOD

A survey was conducted among 661 students (63.5 % females, n = 420, M_age = 21.40). Data were analyzed using structural equation modeling.

RESULTS

A total of 15.9 % (n = 105) of the students had previously taken stimulants to improve their academic performance. The use of stimulants was significantly higher among males (22.4 %) than females (12.1 %). Positive attitudes toward stimulant use for cognitive enhancement were strongest related to students' intention to take stimulants for increasing their academic performance, followed by the norm of parents. Additionally, the more the students identified themselves with the prototype of a student using stimulants for cognitive enhancement, the more likely they were to be willing to misuse stimulants.

CONCLUSIONS

The findings suggest that using stimulants for cognitive enhancement is a rational choice rather than an unplanned one.

Off-label prescribing of stimulant medication to students: a qualitative study on the general practitioner perspective

Students' use of prescription stimulants to enhance study performance is increasingly under the spotlight. Medical guidelines discourage general practitioners (GPs) from prescribing stimulants to students without a diagnosis; yet a considerable proportion of students acquire them from GPs. Building on Eisenberg's theoretical framework on clinical decision-making and Conrad's sociological concept of biomedical enhancement, this study examined the social context of GPs' off-label prescribing decisions for stimulants, using data from 21 semi-structured interviews, including vignettes, undertaken with Flemish GPs. Results identified two groups of GPs: (1) hard-liners who strictly follow medical guidelines and who would only prescribe in case of an appropriate diagnosis and (2) context-dependent GPs who would prescribe stimulants depending on the patients' symptoms and extent of need. GPs' decisions depend on one-on-one doctor-patient interactions (i.e. the extent of empathy from the doctor and the extent of assertiveness from the patient); the extent to which GPs define concentration problems as medical problems; GPs' interactions with fellow health care workers; as well as GPs' interaction with the wider community. By disentangling these influences, this paper advances both theoretical and practical understanding of the sociological context in which GPs' off-label prescribing behaviour occurs.

Psychosocial functioning among college students who misuse stimulants versus other drugs

The misuse of prescription stimulants (e.g., Ritalin, Adderall) is a large and growing problem on college campuses. Emerging research examines not only the demographic predictors of stimulant misuse but also the potentially role that stimulant misuse plays in a college student's overall functioning and mental health. To better understand the experiences specifically linked with stimulant misuse rather than substance use more broadly, we tested whether psychosocial functioning differed across four groups of college students: those who do not misuse stimulants or other hard drugs; those who misuse both stimulants and other hard drugs; those who misuse stimulants but not other hard drugs; and those who misuse other hard drugs but not stimulants (N = 1534; 40.3% male; 33.9% ethnic minority). Those who misused stimulants reported higher levels of impulsivity, as well as substance use consequences, than those who did not use any hard drugs. However, these differences were exacerbated among those who misused stimulants and other hard drugs. Taken together, these findings suggest that stimulant misuse typically occurs in a broader pattern of substance use, and that stimulant misusers generally fall along a continuum of substance use severity in terms of psychosocial functioning.

Power of the Peer and Parent: Gender Differences, Norms, and Nonmedical Prescription Opioid Use Among Adolescents in South Central Kentucky

This study examined risk factors of nonmedical prescription opioid use (NMPOU) among adolescents and how risk factors differ by gender. In the fall of 2017, adolescents attending 6th through 12th grades across 44 schools in 10 south central Kentucky counties were invited to participate in an anonymous, school-based survey. A total of 11,761 adolescents completed the survey. Logistic regression was conducted to examine the association between NMPOU and constructs of the Theory of Reasoned Action (i.e., attitudes and subjective norms), descriptive norms (i.e., peer use), and parental control of prescription medications in the home. There were 297 (2.7%) adolescents who reported NMPOU in the past 12 months. In the adjusted multivariate logistic regression model, for both males and females, the adolescents who perceived that more of their peers engaged in NMPOU were significantly more likely to endorse NMPOU, whereas male and female adolescents who perceived their peers disapproved of use were significantly less likely to report NMPOU. Parent disapproval was significantly associated with decreased NMPOU for females only. Moderated regression analyses revealed that gender moderated the relationship between parental disapproval and NMPOU. We found that during adolescence, NMPOU is influenced by peer norms for both genders and parental norms for females. These results indicate that prevention efforts should focus on changing adolescents' peer and parental norms related to NMPOU.

Making a higher education institution choice: differences in the susceptibility to online information on students’ advice-seeking behavior

Purpose

Little research has been done on how university information sources influence advice-seeking attitude, intention, and behavior between students with high and low susceptibility to online information. Our study addressed this gap by empirically demonstrating the role that students’ susceptibility to online information plays in terms of the effect of attitude, social norm and perceived behavioral control on their advice-seeking intention and behavior using the Theory of Planned Behavior (TPB). The purpose of this study is to examine differences in the susceptibility to online sources on students’ advice-seeking behavior when making an institution choice.

Design/methodology/approach

A cross-sectional survey was involved, and this empirical study was performed on the basis of a sample of 621 students from publicly-funded high schools in Hong Kong. Multigroup analysis (MGA) was conducted to (i.e. students with high susceptibility to online sources/ students with low susceptibility to online sources) to examine students’ behavioral intention regarding advice seeking about institution choice. 10;

Findings

The results of the study revealed that students with high susceptibility to online information were likely to be influenced by the social norm in applying the TPB model. Conversely, students with low susceptibility to online information had low intention to seek advice from others as they are independent and noninformation seekers. Implications for higher education institutions are discussed.

Originality/value

This study provides a modified version of the TPB model while also demonstrating how students with high/low susceptibility to online sources affect their behavioral intention to seek advice from others about making a university choice. Also, this study provides insights into institutions regarding the promotion of marketing information via online and offline sources.

Prescription Stimulant Misuse and Risk Correlates among Racially-Diverse Urban Adolescents

BACKGROUND

Most research on prescription stimulant misuse has focused on college students, and research on high school-aged adolescents is limited.

OBJECTIVES

This study aimed to characterize risk correlates of prescription stimulant misuse among a racially-diverse and socioeconomically-disadvantaged sample of urban adolescents.

METHOD

Cross-sectional data were drawn from an ongoing study of adolescent health behaviors, Project Teen. Participants were 414 9^th to 11^th graders (M_age=16.00 [SD = 1.08]; 57% female; 41% Black or African American, 22% White, 18% Asian, 17% Multiracial, 2% Pacific Islander, and 1% Native American; 12% Hispanic/Latinx). Participants completed a web-based survey assessing prescription stimulant misuse, demographics, mental health and personality, social environment, and substance use.

RESULTS

Eight percent of participants endorsed past-year prescription stimulant misuse. Compared to non-misusing peers, participants endorsing past-year prescription stimulant misuse reported greater depression/anxiety symptoms, sensation seeking, perceived peer risk behavior, and alcohol and cigarette use, as well as a lower level of parental monitoring; null group differences were observed for academic goal orientation, perceived peer approval of risk behavior, and cannabis use. Binary logistic regression demonstrated that binge drinking and cigarette use were significantly associated with prescription stimulant misuse over and above all other identified risk variables.

CONCLUSIONS

Adolescent prescription stimulant misuse appears to overlap with general adolescent substance use, sharing several known risk correlates. Results highlight potential targets for identification of emerging prescription stimulant misuse risk profiles at earlier stages of development. Longitudinal replication is needed to examine directional associations and risk mechanisms underlying adolescent prescription stimulant misuse.

Nonmedical use of prescription drugs during sexual activity as a predictor of condom use among a sample of college students

Objective: To examine the impact of nonmedical use of prescription drugs (NMUPD) during sexual activity on the frequency of condom use among a sample of college students. Participants: Students attending a large Midwestern University (N = 4284) during April 2015. Methods: Retrospective cross-sectional analysis of survey data using logistic regression. Results: Respondents and/or their sexual partners who engaged in NMUPD during sexual activity were significantly less likely to use condoms during 75% or more of past 12-month sexual encounters compared to respondents who had not engaged in lifetime and past 12-month NMUPD. Although not statistically significant, trends suggest that respondents who engaged in NMUPD during sexual activity may be less likely to use condoms than those who engaged in lifetime or past 12-month NMUPD but not during sexual activity. Conclusions: Findings suggest a need for specific strategies for reducing risk behaviors related to prescription drugs and sexual activity.

The impact of a theory-based web-intervention on the intention to use prescription drugs for non-medical purposes among college students: a randomized controlled trial

The non-medical use of prescription drugs (NMUPD) among college students is escalating at an alarming rate. A limited number of studies have utilized a theoretical framework to influence this behavior. To utilize the reasoned-action approach theory to design and evaluate a web-based intervention to influence students' attitudes, perceived norms (PNs), perceived behavioral control (PBC) and intentions toward NMUPD. Using a two-group post-test only controlled trial, students were randomized to view either a general health website or a web-based intervention focused on NMUPD. The intervention was presented in multiple sections to address each component of the reasoned-action approach. Subsequently, respondents completed a web-survey. Independent t-tests were used to compare responses between the two groups. Of 391 respondents, 112 (28.9%) students indicated previous NMUPD. The intervention group had significantly (P = 0.04) more negative attitudes toward NMUPD. No significant differences were found in PNs (P = 0.11), PBC (P = 0.68) or intentions to NMUPD (P = 0.97). The intervention was successful in changing attitudes toward NMUPD. Targeting the intervention toward college students regardless of previous experiences of NMUPD might have led to insufficiency of the intervention to influence intentions. Additional research is needed to improve the intervention dissemination and utilization.

Nonmedical use of prescription drugs for cognitive enhancement as response to chronic stress especially when social support is lacking

The nonmedical use of prescription drugs to improve cognitive performance has gained attention due to concerns over its social and political implications as well as side effects and long-term health consequences. Some researchers expect a future trend of an instrumental use of drugs for cognitive enhancement (CE). Thus, getting insights about causes of CE-drug consumption is warranted before the prevalence increases. Because perceived stress is ubiquitous in universities and may decrease cognitive performance, one reaction to cope with stress and its consequences might be the instrumental use of drugs for CE, especially if other resources, such as social support, are lacking. With a prospective design, randomly selected students from four German universities were invited to a web-based survey and reinterviewed after 6 months (N = 2,203). Results show a 6-month prevalence rate of self-reported CE-drug use of about 2%. Higher reported chronic stress is positively associated with CE-drug use. Although social support has no main effect, stress-buffering effects were found. In men with low stress, more support is associated with a higher chance of self-reported CE-drug use. These findings can inform intervention and prevention strategies such as changes in drug regulation or sensitizing (potential) users to unwanted health consequences.

Popping smart pills in medical school: Are competition and stress associated with the misuse of prescription stimulants among students?

BACKGROUND

There has been increasing attention in both popular and scientific circles to the misuse of prescription stimulants by students. However, it is unclear which student groups are most vulnerable and what environmental factors could influence this misuse. Medical students might be more at risk because of high levels of competition and related stress in medical school, making them a relevant population to explore these interrelationships.

OBJECTIVES

This study aims to answer two research questions: (1) Does competition lead to higher stress and greater likelihood of misuse? and (2) Do the levels of and interrelationships between competition, stress and misuse vary between students with different post-graduate aspirations?

METHODS

In total, 3159 Flemish medical students (48.99% response rate) participated anonymously in a 2016 questionnaire on stimulants. Misuse was defined as use to enhance study performance, but not as part of an applicable treatment. We performed (multiple group) structural equation modeling to answer the research questions.

RESULTS

Results indicate significant associations between competition, stress and misuse: the higher the perception of medical school as being competitive, the higher the stress level and the more likely the misuse. Against our expectations, the association between competition and stress was significantly stronger for future general practitioners (GPs) compared to future specialists.

CONCLUSION

The competitive climate in medical school creates high stress levels, rendering students vulnerable to misuse of stimulants. Students need to be educated about how to cope with stress in a non-pharmaceutical way, making them more resilient to stress during studentship and in their future careers.

Predicting Future Academic Willingness, Intentions, and Nonmedical Prescription Stimulant (NPS) Use with the Theory of Reasoned Action and Prototype/Willingness Model

Background: Nonmedical prescription stimulant (NPS) use for academic reasons (e.g., to improve concentration) is a growing problem among college students. However, there is limited theory-driven research that attempts to identify risk cognitions underpinning decisions to use and NPS use for academic purposes. Furthermore, it is unclear if academic NPS use is characterized by deliberative and/or socially reactive processing and what health decision-making model or combination of models best predicts NPS use decisions and use. Identifying cognitions associated with NPS use decisions is essential to develop interventions aimed at preventing and reducing NPS use. Objective: The present study tested the Theory of Reasoned Action (TRA), Prototype/Willingness Model (PWM), and a combined TRA/PWM model to identify which model best predicts academic NPS use decisions (willingness and intentions) and past 2-month use among college students. Method: Undergraduates (N = 344) participated in a two-wave study assessing T1 constructs from the TRA and PWM as predictors of T2 (2 months later) academic NPS use decisions and use. Results: In the combined TRA/PWM, all T1 constructs were associated with T2 NPS willingness, intentions, and use except for injunctive norms. The integrated model also explained greater variance in T2 use, willingness, and intentions than each model alone. Conclusions/Importance: The combination of cognitions from the TRA/PWM was superior to each individual model and improved the prediction of future NPS use willingness, intentions, and use. The overall results derived from all three models suggest that both deliberative and socially reactive processing influence and characterize academic NPS use decisions and use.

Building Conceptions of Cognitive Enhancement: University Students' Views on the Effects of Pharmacological Cognitive Enhancers

BACKGROUND

Use of prescription stimulants for cognitive enhancement in healthy individuals has been of growing interest to the academic community. University students can be prone to use these pharmacological cognitive enhancers (PCEs) for their perceived academic benefits.

OBJECTIVES

We aimed to understand university students' beliefs about the factors influencing PCE use, the cognitive and health effects of the drugs, and how these conceptions are interrelated.

METHODS

Data were collected through focus groups with 45 students at the University of Toronto in 2015/2016. We used thematic analysis to extract key themes and cooccurrence coefficients to evaluate the overlap between these themes.

RESULTS

We found that participants perceived users as either struggling students or high-achieving ones. Alleged benefits of PCEs included enhanced focus, attention, memorization, and grades, but did not include increased intelligence or long-term cognitive enhancement. Participants disagreed on whether ADHD diagnosis would affect how PCEs worked and how "needing the drug" was determined. Mentions of nonspecific side effects were common, as was the possibility of misuse (e.g., addiction, abuse). Though not an initial aim of the study, we uncovered patterns pertaining to whom participants used as sources of information about different themes. We propose that social learning theory provides a useful framework to explain how the experiences of peers may shape the conceptions of our participants. Conclusions/Importance: Our findings highlight that conceptions surrounding PCEs are multileveled, and informed by a variety of sources, including peers. This should be considered in the development of interventions geared toward university students.

More than just Alcohol: Marijuana and Illicit Drug Use at Parties Attended by 15-20 Year Olds

BACKGROUND

Parties are a common setting for marijuana and illicit drug use among adolescents.

OBJECTIVES

This study examined the context of parties with alcohol, marijuana and illicit drug use attended by adolescents and young adults.

METHODS

In 2016, an address-based sample of 1,764 15-20-year-olds in 24 U.S. communities participated in an online survey. Parties were categorized as alcohol-only (Alc-only), marijuana + alcohol (Mj + Alc), and illicit + marijuana + alcohol (ID + Mj + Alc) based on survey participants' observations and self-reported drug use at the last party attended. Multivariable logistic regression was used to identify correlates of substance use at parties.

RESULTS

1,089 participants (61.7%) reported ever attending a party where alcohol was consumed. Of those, 60.1% reported that the last party they attended had Alc-only, 24.9% had Mj + Alc, and 10.0% had ID + Mj + Alc. Older participants were more likely to attend a party with Mj + Alc or ID + Mj + Alc. Participants whose mother had a college degree (compared to less than a college degree) were less likely to attend a party with ID + Mj + Alc. Parties with Mj + Alc and ID + Mj + Alc were larger and the majority of attendees were under 21. Parties with ID + Mj + Alc were more likely to be majority female compared to mixed gender. Parties with Mj + Alc were more likely to occur at someone else's home and be in states where medical and recreational marijuana use was legal.

CONCLUSION

One-third of parties attended by 15-20-year-olds had marijuana and/or illicit drug use in addition to alcohol consumption. The identified risk factors of parties with marijuana and illicit drug use can be used to develop targeted prevention strategies.

PCE Use in the Workplace: The Open Secret of Performance Enhancement

Increasing evidence suggests employees are turning to the nonprescribed use of stimulants to supplement their performance. We sit in a unique position regarding stimulants in the workforce. They are easily available, there is little stigma attached to use, and there is little information regarding the long-term safety effects of use. With that in mind, almost no formal research has been executed in the realm of organizational behavior. The purpose of this JMI ( Journal of Management Inquiry) Generative Curiosity article is to introduce readers to this literature and identify what we believe are the most important avenues of inquiry for management scholars.

College students' perceived benefit-to-risk tradeoffs for nonmedical use of prescription stimulants: Implications for intervention designs

OBJECTIVES

Few studies have examined the benefit-to-risk tradeoffs undergraduate students perceive when engaging in the nonmedical use of prescription stimulants (NPS). This study examined the variation in college students' perceived risks and benefits for NPS.

METHODS

An online survey was administered to 259 college students (ages 18-25) at six public universities who had engaged in NPS in the past year. A best-worst scaling (BWS) instrument assessed the relative importance of 12 perceived benefits and risks of NPS. Probabilities of selection of each factor and 95% confidence intervals were estimated for the aggregate sample and latent preference subgroups were derived using latent class analysis (LCA).

RESULTS

For the aggregate sample, the strongest motivators for NPS were better grades (m=2.33, p<0.05) and meeting deadlines (m=1.62, p<0.05). The LCA generated four subgroups: 1) assuredly performance-driven (n=64; 25%), who prioritized academic performance and nonacademic responsibilities; 2) cautiously grade/career-oriented (n=117; 45%), who balanced academic improvements with expulsion and limiting future career opportunities; 3) risk-averse (n=64; 25%), who prioritized expulsion above academic improvements; and 4) recreational (n=14; 5%), who most valued having fun partying.

CONCLUSIONS

These findings identify subgroups of college NPS users that could have vastly different trajectories in terms of future drug use and college performance. Given this heterogeneity among students regarding perceived risks and benefits of NPS, interventions should be designed to assess motives and provide personalized feedback. Further research is needed with larger, more diverse samples and to assess the prospective stability of perceived risks and benefits.

Personal and perceived peer use and attitudes towards the use of nonmedical prescription stimulants to improve academic performance among university students in seven European countries

BACKGROUND

Overestimations of non-prescribed stimulant use of peers are well documented in the USA and have also been identified as predictive of personal stimulant consumption. This study aimed to examine whether overestimations of peer use and approval of the use are associated with personal use and attitude towards the use of non-prescribed stimulants among European university students.

METHOD

The EU funded 'Social Norms Intervention for the prevention of Polydrug usE (SNIPE)' study was conducted in seven European countries. In a web-based questionnaire, 4482 students were asked about their personal use and their attitude towards non-prescribed stimulant use, as well as the perceived peer use and peer attitude.

RESULTS

59% of students thought that the majority of their peers used non-prescribed stimulants more frequently than themselves, and only 4% thought that the use of the majority was lower than their personal use. The perception that the majority of peers had used non-prescribed stimulants at least once was significantly associated with higher odds for personal use of non-prescribed stimulants (OR: 3.30, 95% CI: 2.32-4.71). In addition, the perception that the majority of peers approved of the non-prescribed use of stimulants was associated with a 4.03 (95% CI: 3.35-4.84) times higher likelihood for personal approval.

DISCUSSION

European university students generally perceived the non-prescribed use of stimulants of peers to be higher than their personal use. This perception, as well as a perception of higher approval in the peer group, was associated with a higher likelihood of personal non-prescribed stimulant medication use and approval.

Nonmedical use of prescription stimulants in college students: Attitudes, intentions, and vested interest

INTRODUCTION

Research on vested interest theory (VIT) indicates that the importance and hedonic relevance of attitudes moderates the link between attitudes and attitude-congruent behavior. Though largely untested in prevention research, this relationship may prove crucial in determining the success or failure of prevention efforts. The current study was designed to determine if subjectively perceived vested interest maximized the association between attitudes and intentions regarding the nonmedical use of prescription stimulants (NUPS).

METHODS

A cross-sectional survey was conducted with college student respondents (N=162) using Amazon's MTurk. Participant age ranged from 19 to 49years old. A subsample analysis (n=129) was also conducted with younger respondents, as the typical college student is usually under the age of 30.

RESULTS

Four-step hierarchical regression analysis indicated that both attitudes and perceived vested interest were significantly associated with NUPS behavioral intentions (p<.001). Further, vested interest moderated the relationship between stimulant-related attitudes and usage intentions (p<.001). Attitudes were significantly associated with intentions of moderately and highly vested respondents (p<.001), but not those of participants expressing low levels of perceived vested interest.

CONCLUSIONS

Findings support the proposition that vested interest may be a useful target for attenuating NUPS. Rather than attempting to weaken positive attitudes toward NUPS, campaigns may prove more successful if designed to convince receivers that NUPS is not in their best interest.

Associations Between the Big Five Personality Traits and the Non-Medical Use of Prescription Drugs for Cognitive Enhancement

While the number of studies of the non-medical use of prescription drugs to augment cognitive functions is growing steadily, psychological factors that can potentially help explain variance in such pharmaceutical cognitive enhancement (CE) behavior are often neglected in research. This study investigates the association between the Big Five personality traits and a retrospective (prior CE-drug use) as well as a prospective (willingness to use CE drugs) measure of taking prescription drugs with the purpose of augmenting one's cognitive functions (e.g., concentration, memory, or vigilance) without medical necessity. We use data from a large representative survey of German employees (N = 6454, response rate = 29.8%). The Five Factor Model (FFM) of Personality was measured with a short version of the Big Five Personality Traits Inventory (BFI-S), which includes: openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. Together with this, demographic variables such as gender, age, education, and income were used as potential confounders in multiple logistic regression models. Our results show a 2.96% lifetime prevalence of CE-drug use and a 10.45% willingness to (re)use such drugs in the future. We found that less conscientious and more neurotic respondents have a higher probability of prior CE-drug use and a greater willingness to use CE drugs in the future. No significant effects were found for openness, extraversion, or agreeableness. Prior CE-drug use was strongly associated with a greater willingness to take such drugs in the future. This study shows that specific personality traits are not only associated with prior enhancement behavior, but also affect the willingness to (re)use such drugs. It helps increase understanding of the risk factors of CE-drug use, which is a health-related behavior that can entail severe side-effects for consumers. The knowledge gathered can thus help improve interventions aimed at minimizing health problems.