A Multi-Method Examination of Social Norms for Medical Prescription Drug Use and Non-Medical Prescription Drug Use among Post-Secondary Students

Abstract

My dissertation sought to investigate social norms of potentially harmful medical and non-medical prescription drug use (PDU/NMPDU) among emerging adults (EAs). Social norms interventions can curb certain substance use behaviours among EAs. Yet no comprehensive investigation has explored whether such interventions might be useful for PDU/NMPDU in this population. Quantitative, qualitative, and mixed-methods research approaches were used to examine this issue in three studies focused on the most commonly-used categories of psychoactive prescription drugs: opioids, stimulants, and sedatives/tranquilizers. Study 1 explored the influence of sex on descriptive social norms surrounding NMPDU in N=1986 university students. Correlational and linear mixed models results highlighted participants perceiving more peer use were significantly more likely to engage in use themselves. While females perceived more frequent peer use than male participants, significant positive correlations were found between perceived peer use frequency and participants’ own use regardless of peer and/or participant sex. Study 2 involved six qualitative focus groups with N=39 university students who endorsed engaging in recent PDU or NMPDU. Focus groups explored normative perceptions of PDU/NMPDU. A thematic analysis generated three themes (each with three subthemes) highlighting that (1) PDU/NMPDU was perceived to be common, (2) certain contexts were perceived to facilitate higher usage, and (3) individual characteristics were perceived to influence use. Study 3 involved testing a single session, group-based, social norms intervention that was delivered to N=36 university students who had endorsed recent PDU/NMPDU. ANOVAs of pre-post quantitative data showed that while providing corrective social norms information during the session significantly decreased participants’ overestimations of peer PDU/NMPDU, post-intervention perceptions were still significantly higher than actual use rates. Additionally, participants did not demonstrate a significant reduction in their intention to use prescription drugs post-intervention. A content analysis of qualitative participant reflections about the intervention revealed several issues that could be improved upon to potentially enhance efficacy of social norms interventions for student PDU/NMPDU (e.g., enhancing student ‘buy-in’). Taken together, the three dissertation studies highlight that many individual- and group-level factors such as social networks and overall ‘buy-in’ would be important considerations in determining which information and referents to include in social norms interventions.