A review of risk and protective factors associated with prescription drug misuse among adolescents: A Social-Ecological Perspective

Background: Non-medical use of prescription drugs (NMUPD) is a significant public health concern, particularly with respect to the associated increased risk of medical complications, overdose, and death, all of which have increased dramatically within the past decade. The purpose of this study is to identify the strongest and most consistent risk and protective factors associated with NMUPD in multiple social-ecological contexts, specifically in social-, school-, and individual-level domains.

Methods: A literature search was conducted to review studies published from 2006-2012 that examined NMUPD among 14-24-year-olds. Original research studies that focused specifically on risk and protective factors or review articles that included a section on factors associated with NMUPD were included.

Results: 49 articles met inclusion criteria. A variety of risk and protective factors were associated with adolescent NMUPD. At the social level, parent and peer prescription drug use and approval of NMUPD, as well as ease of access to prescription drugs, were associated with misuse of prescription drugs. At the school level, academic failure/low educational attainment was associated with NMUPD among high school students; however, results regarding NMUPD and academic failure among college students were inconclusive. At the individual level, previous use of substances was found to be a significant risk factor for NMUPD, as was adolescent aggressive/delinquent behavior and lower perceived risk or harm of use.

Conclusions: Several areas for prevention efforts within the context of the community, school, and individual domains exist. Multifaceted approaches are needed that target factors across multiple levels of the social-ecological model.