stimulants (Herman-Stahl, Krebs, Kroutil, & Heller, 2007; Kroutil et al., 2006; Low ...... 1990) and persons in treatment for substance abuse (Ehrman et al., 1997; ...
© 2008 BY THE JOURNAL OF DRUG ISSUES
NONMEDICAL PRESCRIPTION
DRUG
USE AMONG
HISPANICS JASON A. FORD, FERNANDO I. RIVERA
Past research shows distinct racial/ethnic differences in substance use. Given the changing racial/ethnic composition of the United States, continued research in this area is important. This is especially true for Hispanics, the fastest growing and largest minority group in the United States. One area of particular importance is nonmedical prescription drug use. The rate of nonmedical prescription drug use has increased substantially in recent years, and current research shows that the prevalence of nonmedical prescription drug use is now greater than the prevalence of the use of illicit drugs other than marijuana. With an emphasis on Hispanics, the current study examines racial/ethnic variation in nonmedical prescription drug use using a large, national sample of adolescents and young adults. Findings indicate that Hispanics are less likely to report nonmedical prescription drug use than Whites, but more likely to report use than Blacks and Asians. Additional analyses, conducted using Hispanic respondents only, indicate that acculturation is significantly associated with nonmedical prescription drug use. INTRODUCTION
Nonmedical prescription drug use is defined as use without a prescription from a doctor or use solely for the feeling or experience caused by the drug, and includes the use of opiate-type pain relievers, tranquilizers, stimulants, and sedatives (Substance Abuse and Mental Health Services Administration [SAMHSA], 2006). In recent years there has been a sizeable increase in nonmedical prescription drug use, especially among adolescents and young adults (Gledhill-Hoyt, Lee, Strote, & Wechsler, 2000; Johnston, O'Malley, Bachman, & Schulenberg, 2006; Mohler-Kuo, Lee, & Wechsler, 2003; SAMHSA, 2006). The increase has been so dramatic that
Jason A. Ford, Ph.D., is an assistant professor of sociology at the University of Central Florida. His research interests are substance use, antisocial behavior over the life course, and sports participation and deviance. Fernando I. Rivera, Ph.D., is an assistant professor in the department of sociology at the university of Central Florida. His research and teaching interests are in the areas of mental health, family social support, and discrimination, with a special emphasis on Latino groups.
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recent national surveys of substance use indicate that the prevalence of nonmedical prescription drug use is now greater than the prevalence of illicit drug use, other than marijuana (Johnston et al., 2006; McCabe, Teter, & Boyd, 2006; SAMHSA, 2006). The empirical research has not kept pace with the increase in nonmedical prescription drug use; consequently, many questions remain unanswered. Of particular concem is that nonmedical prescription drug use has been mostly investigated among White adolescents and young adults, paying little to no attention to the pattems of use of other racial/ethnic groups. The lack of research investigating racial/ethnic differences in nonmedical prescription drug use represents an important gap in the literature. The examination of racial/ethnic pattems in use is a common area of study in substance use research. Studies of racial/ethnic variation in marijuana and other illicit drug use generally indicate that Whites report the highest prevalence of use, followed by Hispanics, with Blacks and Asians reporting lower rates of use (Barnes, Farrell, & Banerjee, 1994; Broman, Reckase, & Freedman-Doan, 2006; Johnston et al., 2006). Although not studied as often as other racial/ethnic groups, research indicates that Native Americans report higher rates of substance use than other racial/ethnic groups (Beauvais, 1996; Oetting & Beauvais, 1990; Plunkett & Mitchell, 2000; Wallace et al., 2003). An important discovery in recent research indicates that the traditional racial/ethnic differences in substance use may be changing. Findings from the 2005 National Survey on Drug Use and Health indicate that rates of past year illicit drug use are very similar for White 20.5%, Black 20.4%, and Hispanic 19.6% adolescents, while rates are much lower for Asians 7.6% (SAMHSA, 2006). The need to examine racial/ethnic differences in nonmedical prescription drug use is particularly relevant given the increasingly diverse racial/ethnic makeup of the U.S. population. In 1980 only 17% of the U.S. population was non-White, but the percentage of non-Whites increased to 25% in 2000 and is destined to continue increasing (U.S. Census Bureau, 2006). Primarily responsible for this change is the substantial increase in the number of Hispanics living in the U.S. between 1980 and 2000. During this period the number of Hispanics increased from 14.6 million to 35.3 million (U.S. Census Bureau, 2006). Hispanics are the fastest growing and now the largest minority group in the U.S. (U.S. Census Bureau, 2006). Because of the substantial growth of the Hispanic population we believe it is important to compare substance use by Hispanics to members of other racial/ethnic groups. We believe it is important to recognize Hispanics for a number of reasons. First, Hispanics are a younger population than non-Hispanics, with around 40% under the age of 21 (Ramirez & de la Cruz, 2002). This is relevant given that adolescents and young adults report the highest prevalence of substance use (Johnston et al., 2006; SAMHSA, 2006). Research also indicates that Hispanic adolescents are at an increased risk for substance use and abuse (Vega & Gil, 1999). This is, in part, 286
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due to their rapid population growth and minority status, which is compounded by high poverty rates, low educational attainment, high rates of housing segregation, and overrepresentation in the juvenile justice system (Molina, Molina, & Zambrana, 2001 ). Second, research comparing the prevalence of substance use by Hispanics to other racial/ethnic groups has traditionally found that Hispanics use less than Whites, but more than Blacks and Asians (Beauvais & Oetting, 2002; Johnston et al., 2006; Ma & Shive, 2000; Parker, Weaver, & Calhoun, 1995; Vega, Zimmerman, Warheit, Apospori, & Gil, 1993; Warner et al., 2006). However, recent research indicates I an increase in substance use among Hispanic adolescents and young adults. In the early 1990s Hispanics had significantly lower rates of substance use than Whites or j Blacks; however, substance use among Hispanics has increased substantially since then and is now comparable to or greater than use by Whites (De La Rosa, 2002). Third, substance use among Hispanics appears to be more problematic. Hispanics I are more likely to initiate substance use at an early age, prior to age 13, than other ' racial/ethnic groups (Delva et al., 2005; Johnston et al., 2006). Hispanics also have higher rates of use for several "hard" drugs, asfindingsfi"omthe 2005 Monitoring j the Future Study indicate that Hispanics have the highest rates of use for cocaine, I crack, heroin, and crystal methamphetamine (Johnston et al., 2006). The youthful makeup of the Hispanic population in the United States, recent trends of increased substance use among Hispanics, and the problematic nature of substance use by Hispanics suggest that research focusing on Hispanic populations is important. NONMEDICAL PRESCRIPTION DRUG USE
The latest findings on nonmedical prescription drug use from the 2005 National Survey on Drug Use and Health indicate that around 20% of the U.S. population over the age of 12 report use at some point in their lifetime (SAMHSA, 2006). Regarding specific classes of prescription drugs, 13% report use of opiate-type pain relievers, 9% report use of tranquilizers, 8% report stimulant use, and 4% report sedative use (SAMHSA, 2006). These findings highlight the growing trend in nonmedical prescription drug use in recent years. There was a 95% increase in use between 1992 and 2003 in the general population, with a 212% increase in use among adolescents I ages 12 to 17 (The National Center on Addiction and Substance Abuse at Columbia [ University, 2005). Research also indicates high rates of use among young adults. The 2001 College Alcohol Study, a national sample of college students in the I United State, examines the prevalence of nonmedical prescription drugs among young adults. Findings indicate that about 18% of students report nonmedical use of any prescription drug in their lifetime: 12% report the use of opiates, 8% report tranquilizer use, 7% report stimulant use, and 6% report sedative use (Wechsler, ! 2005). There is speculation that the growing popularity of nonmedical prescription drug use is based on the assumed advantages of using prescription drugs compared I WINTER 2008
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to "street" drugs. The argument is that prescriptioti drugs are easier to obtain, there is less likelihood of arrest, use is more socially accepted, and there is a perception that prescription drugs are safer (Cicero, Inciardi, & Munoz, 2005). The relatively scant research literature on the topic is surprising given the dramatic increases in use and the abundance of research on substance use among adolescents and young adults. One notable shortcoming of the existing literature on nonmedical prescription drug use is that it is primarily based on findings from school-based samples (i.e., Monitoring the Future, College Alcohol Study, and the Student Life Survey). There is a clear need for research analyzing data from samples that are more representative of the U.S. population (i.e.. National Survey on Drug Use and Health). The majority of research on nonmedical prescription drug use generally focuses on the use of opiate-type pain relievers (McCabe, Teler, & Boyd, 2005; McCabe, Teter, Boyd, Knight, & Wechsler, 2005; Sung, Richter, Vaughan, Johnson, & Thom, 2005; Zacny et al, 2003) or the use of prescription stimulants (Herman-Stahl, Krebs, Kroutil, & Heller, 2007; Kroutil et al., 2006; Low & Gendaszek, 2002; McCabe, Knight, Teter, & Wechsler, 2005; Teter, McCabe, Boyd, & Guthrie, 2003; Teter, McCabe, Cranford, Boyd, & Guthrie, 2005). While there are a few studies that examine the nonmedical use of any prescription drug (McCabe, 2005; Simoni-Wastila & Strickler, 2004), there is very limited research on the nonmedical use of tranquilizers (McCabe, 2005) or sedatives. The existing research examines demographic characteristics of users. Similar to other forms of substance use, adolescents and young adults are at the greatest risk for nonmedical prescription drug use (Johnston et al., 2006; SAMHSA, 2006). Research findings on gender differences in nonmedical prescription drug use are inconclusive. Some research finds that males report higher rates of use (Kroutil et al., 2006; McCabe, 2005; McCabe et al., 2006; McCabe, Knight et al., 2005), while others report that females are more likely to use (Simoni-Wastila & Strickler, 2004; Simoni-Wastila et al., 2004; Sung et al., 2005). Finally, research indicates that Whites are at increased risk for nonmedical prescription drug use compared to non-Whites (Herman-Stahl et al., forthcoming; Kroutil et al., 2006; McCabe, 2005; McCabe et al., 2006; McCabe, Teter, Boyd, Knight et al., 2005; McCabe, Teter, & Boyd, 2005; Simoni-Wastila & Strickler, 2004; Sung et al., 2005). Beyond these basic demographic characteristics there is some additional research on other risk factors associated with nonmedical prescription drug use. Individuals who report poor physical health (Simoni-Wastila & Strickler, 2004; Simoni-Wastila et al., 2004), or mental health problems (Herman-Stahl et al., forthcoming; Hser, Hoffinan, Grella, & Anglin, 2001 ; Matzger & Weisner, 2007) are at an increased risk for nonmedical prescription drug use. These health correlates signal the possibility that individuals may be self-medicating with prescription drugs. It is possible that 288
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individuals, who cannot obtain prescription drugs legally, may be obtaining them via ¡ other means in order to treat health-related problems. Prior research indicates that I the strongest predictor of nonmedical prescription drugs use is the use of marijuana or other illicit drugs (Herman-Stahl et al., forthcoming; McCabe, 2005; McCabe ' et al., 2006; McCabe, Teter, & Boyd, 2005; McCabe, Knight et al., 2005; SimoniWastila & Strickler, 2004; Simoni-Wastila et al, 2004; Sung et al., 2005). These ]findingssuggest that nonmedical prescription drug use may simply be another form of substance use and not a unique phenomenon. There is a noticeable lack of research examining racial/ethnic differences in 1 nonmedical prescription drug use. Most research simply compares Whites to all ! other respondents. Furthermore, only a handful of studies include Hispanics as a ^ distinct racial/ethnic group in their analysis. These studies indicate that Hispanics are less likely to use stimulants than Whites (Herman-Stahl, Krebs, & BCroutil, 2006; ! Herman-Stahl et al., 2007; Kroutil et al., 2006). However, these studies do not look I at other types of prescription drug use (pain relievers, tranquilizers, or sedatives) and do not compare the use of Hispanics to other racial/ethnic groups like African Americans or Asians. One study using the Student Life Survey, a sample of college 'student at the University of Michigan, reports that Hispanics have the highest prevalence of nonmedical prescription drug use, although this was only a bivariate analysis (McCabe, 2006). The purpose ofthe current research is to examine the relationship between race/ 'ethnicity and nonmedical prescription drug use, with an emphasis on Hispanics. ¡Given the substantial increase in nonmedical prescription drug use in recent years and the relatively high prevalence of nonmedical prescription drug use compared to other forms of substance use we believe this research is important. There is 'also a lack of research providing a detailed examination of racial/ethnic variation in nonmedical prescription drug use with data from a nationally representative sample. It is important to determine whether existing racial/ethnic pattems in other forms of substance use are similar to or different than the racial/ethnic pattems in nonmedical prescription drug use. In addition, the majority of research on racial/ ethnic differences in substance use generally examines bivariate differences in use, or simply includes race/ethnicity as a control for substance use. More research is heeded examining the racial/ethnic variation in substance use while controlling for known predictors of substance use. Furthermore, as the U.S. becomes more racially/ethnically diverse and the Hispanic population continues to grow, it is necessary to understand the racial/ethnic pattems in this emerging form of substance use. It is important to understand whether current demographic changes in the racial/ethnic makeup ofthe U.S. population, especially those experienced by Hispanics, have an impact on racial/ethnic pattems WINTER 2008
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in substance use. Therefore, the current research singles out Hispanics as the racial/ ethnic group of primary interest, comparing nonmedical prescription drug use by Hispanics to other racial/ethnic groups. We believe this strategy is important for a number of reasons. First, Hispanics are the fastest growing, largest, and youngest minority group in the United States. Second, Hispanics initiate substance use at a younger age and report more problematic substance use than other racial/ethnic groups. Third, recent research indicates increased substance use among Hispanics. All of this indicates a clear need to focus on Hispanics as a group of interest in substance use research. In addition, most of the existing research on nonmedical prescription drug use ignores Hispanics. We believe that the current research makes a significant contribution to the literature on racial/ethnic differences in substance use, in general, and more specifically increases our understanding of nonmedical prescription drug use. HYPOTHESES
There is a lack of research examining racial/ethnic differences in nonmedical prescription drug use; therefore, our research hypotheses are guided by prior research examining racial/ethnic differences in other forms of substance use. We expect Hispanics to be less likely to report nonmedical prescription drug use than are Whites. We expect Hispanics to be more likely to report nonmedical prescription drug use than are Blacks or Asians. Finally, we expect Hispanics to be less likely to report nonmedical prescription drug use than "other" racial/ethnic groups. This is likely because the "other" racial/ethnic group includes Native Americans, who report very high levels of substance use. RESEARCH METHODOLOGY
This study uses data from the 2005 National Survey on Drug Use and Health (NSDUH), an ongoing household survey of individuals' ages 12 and older in the United States (U.S. Department of Health and Human Services, 2006). The primary goal of the NSDUH, formerly known as the National Household Survey on Drug Abuse, is to measure the prevalence and correlates of substance use in the United States. A multistage area probability sample for all 50 states and the District of Columbia is used to collect data from a sample of 68,308 civilian, noninstitutionalizes persons. The public-use data file used in the current study contains data from only 55,905 respondents. This reduction in sample size is due to a subsampling step used in the disclosure protection procedures, to control for the risk of disclosing the identity of any respondent (U.S. Department of Health and Human Services, 2006). Given the high rates of substance use among adolescents and young adults, the current study limits analyses to respondents ages 12 thru 25, which further 290
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reduces the sample size to 37,154 respondents. In an effort to minimize missing responses during the collection of the data, statistical imputation was performed ! following logical inference to replace missing responses on selected variables (U.S. Department of Health and Human Services, 2006). Therefore, in the current study, only eleven cases were removed from the analyses due to missing data. I The dependent variable for the current study is nonmedical prescription drug use ' in the past year, and is operationalized as a dichotomous variable (0 = No, 1 = Yes). I The NSDUH defines nonmedical use as use without a prescription from a doctor or ' solely for the feeling or experience caused by the drug. This analysis examines the nonmedical use of any prescription drug, which includes the use of opiate-type pain ; relievers (i.e., Darvocet, Percocet, Vicodin, codeine, and Demerol), tranquilizers ' (i.e., klonopin, xanax, ativan, valium, and librium), stimulants (i.e., Ritalin, Cylert, Dexedrine, and adderall), and sedatives (i.e., halcyon. Phénobarbital, seconal, and restoril). In addition to the nonmedical use of any prescription drug, each class of prescription drug is also analyzed separately. The independent variable of interest in this study is race/ethnicity. Respondents are divided into five different racial/ethnic groups: Hispanic, White, Black, Asian, i and Other. The "other" category includes respondents who are Native Hawaiian/ Pacific Islander, Native American/Alaskan Native, or report more than one racial/ ethnic group. The goal of this research is to compare Hispanics to the other racial/ ethnic groups. To do this race/ethnicity is modeled as a categorical predictor, with "Hispanic" as the reference group, in the multivariate models. I Several demographic characteristics, as well as some established correlates of ' nonmedical prescription drug use, are included as controls in the multivariate models. Gender is coded as (0) female and (1) male. Age is also coded as a dichotomous ¡variable, (0) 12-17 years old and (1) 18-25 years old. While the NSDUH includes ' respondents of all ages, the analysis is limited to respondents between the ages of 12 and 25 because adolescents and young adults report the highest levels of substance use, in general, and nonmedical use of prescription drugs in particular. A measure of total family income is also included: (a) less than $20,000, (b) $20,000 to $49,999, (c) $50,000 to $74,999, and (d) $75,000 or more. Population density is also included :(a) respondent lived in a Core Based Statistical Area (CBSA) larger than one million persons, (b) respondent lived in a CBSA smaller than one million persons, and (c) respondent did not live in a CBSA. In addition, respondents' are ¡asked to report their overall health: (a) fair or poor, (b) good, (c) very good, or (d) excellent. Finally, respondents are asked if they had any form of health insurance: (0) covered by some form of health insurance, ( 1 ) not covered by any health insurance. These measures are commonly included in regression models predicting nonmedical prescription drug use (Herman-Stahl et al., forthcoming; Herman-Stahl, Krebs, JWINTER 2008
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&Kroutil, 2006; Kroutil et al., 2006; Simoni-Wastila & Strickler, 2004; SimoniWastila et al., 2004). Prior research shows that other forms of substance use are strong correlates of nonmedical prescription drug use; therefore, three measures of substance use are included in the multivariate models. Alcohol use is defined as heavy episodic drinking and is coded (0) No, (1) Yes. The NSDUH defines heavy episodic drinking as drinking five or more drinks on the same occasion on at least one day in the past 30 days. Given that alcohol use is very prevalent among adolescents and young adults, we believe that heavy episodic drinking is a more appropriate measure. Respondents were also asked if they used marijuana in the past year: (0) No, (1) Yes. The final substance use measure is the use of "hard" drugs in the past year (0) No, (1) Yes, and includes the use of cocaine, crack, heroin, hallucinogens, LSD, PCP, ecstasy, inhalants, or methamphetamines. ANALYTIC STRATEGY
In this research the racial/ethnic variation in nonmedical prescription drug use is examined using data from a large national sample of adolescents and young adults. Data analysis is conducted in three stages. First, the bivariate relationship between race/ethnicity and nonmedical prescription drug use is examined via a series of chisquare tests. Second, baseline regression models are estimated with demographic characteristics and two health-related measures included as controls. Third, complete regression models are estimated by adding measures of substance use to the baseline model. Because prior research indicates that alcohol and other drug use are strong correlates of nonmedical prescription drug use, we believe it is useful to estimate the models without substance use measures included. All statistical models are estimated forfivedifferent dependent variables: nonmedical use of any prescription drug, opiate-type pain relievers, tranquilizers, stimulants, and sedatives. In order to take into account the complex multistage sampling design of the NSDUH, analyses are conducted using the SVYSET and SVY commands in STATA. These commands allow STATA to consider survey design effects, including stratification and weight variables and the primary sampling unit, when estimating test statistics. FINDINGS
The descriptive statistics for all variables are shown in Table 1. Approximately 12% of adolescents and young adults report the nonmedical use of any prescription drug in the past year. The class of prescription drugs with the highest prevalence of use was opiate-type pain relievers (10%), followed by tranquilizers (4%), stimulants (3%), and sedatives (0.5%). These findings also indicate that the prevalence of nonmedical prescription drug use was higher than the prevalence of "hard" drug 292
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NONMEDICAL PRESCRIPTION DRUG USE AMONG HISPANICS TABLE 1 SAMPLE CHARACTERISTICS ( N = 37,143) Dependent Variables Any prescription drug use Pain reliever Tranquilizer Stimulant Sedative
12.09% 9.99% 3.98% 2.90% 0.50%
Race/Ethnicity Hispanic White Black Asian Other
17.54% 61.36% 14.35% 4.43% 2.32%
Demographic Controls Gender Female Male
49.37% 50.63%
Age 12-17 years old 18-25 years old Family Income Less than $20,000 $20,000 - $49,999 $50,000 - $74,999 $75,000 or more
26.00% 34.66% 15.41% 23.93%
Population Density CBSA larger than 1 million CBSA smaller than 1 million Not in a CBSA
52.06% 41.42% 6.52%
Health Related Measures OveraU Health Fair/poor Good Very good Excellent
4.94% 22.79% 40.92% 31.35%
Health Insurance Covered No coverage
81.06% 18.94%
Substance Use Measures Heavy episodic drinker Marijuana user Hard drug user
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43.84% 56.16%
27.83% 21.71% 9.78%
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use, as only 10% ofthe respondetits report the use of "hard" dmgs. Regarditig race/ethnicity, about 18% ofthe sample is Hispanic, 61% is White, 14% is Black, 4% is Asian, and 2% is classified as an "other" race. Ofthe respondents who are classified as "other," the majority reports being more than one race. To begin, the bivariate relationship between race/ethnicity and nonmedical prescription drug use is examined, findings shown in Table 2. There are significant racial/ethnic differences in the use of any prescription drug, as well as for the use of pain relievers, tranquilizers, and stimulants. For all of these categories of nonmedical prescription drug use. Whites report the highest prevalence of use followed by other, Hispanics, Blacks, and Asians. The analyses show that Hispanics are less likely to report use than Whites, but they are more likely to report use than Blacks and Asians, The findings of the baseline logistic regression model, with demographic characteristics and two health-related measures as controls, are shown in Table 3. The analyses indicate significant racial/ethnic differences in notimedical prescription drug use. Whites are more likely to report the nonmedical use of any prescription drug (O.R. = 1.74), opiate-type pain relievers (O.R. = 1.82), tranquilizers (O.R. = 3.19), and stimulants (O.R. = 1,92) than Hispanics. The "other" racial/ethnic group is also more likely to report the nonmedical use of any prescription drug (O.R. = 1.42), opiate-type pain relievers (O.R. = 1.46), tranquilizers (O.R. = 2.02), and stimulants (O.R. = 1.79) than Hispanics. The findings also show that both Blacks and Asians are less likely to report nonmedical prescription drug use than Hispanics. Black respondents are less likely to report the use of any prescription drug (O.R. = 0.71), opiate-type pain relievers (O.R. = 0.79), tranquilizers (O.R. = 0.47), and stimulants (O.R. = 0.29), while Asian respondents are less likely to report the use of any prescription drug (O.R. = 0.41), opiate-type pain relievers (O.R. = 0.45), tranquilizers (O.R. = 0.24), and stimulants (O.R. = 0.43). Several of the controls are also significantly associated with nonmedical prescription drug use. Respondents between the ages of 18 and 25 are more likely to report use than respondents ages 12 to 17. There is an inverse relationship between income and nonmedical prescription drug use; respondents who report a fatnily income under $20,000 are more likely to report use. Finally, both healthrelated measures are significantly associated with nonmedical prescription drug use. Respondents who rate their overall health as being fair or poor are more likely to report use, and respondents who do not have any form of health insurance are more likely to report use than those who do have health insurance. The findings for the complete model, which adds three substance use measures to the baseline model, are shown in Table 4. For the nonmedical use of any prescription drugs. Whites (O.R. = 1.30) are more likely to report use than Hispanics, while Blacks 294
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NONMEDICAL PRESCRIPTION DRUG USE AMONG HISPANICS TABLE 2 PROPORTION REPORTING NONMEDICAL PRESCRIPTION DRUG USE BY RACE/ETHNICITY
Any
Pain
Tranquilizer
Stimulant
Sedative
Hispanic
9.89%
7.73%
2.21%
2.20%
0.62%
White
14.52%
11.98%
5.46%
3.77%
0.54%
Black
6.81%
6.24%
0.92%
0.60%
0.34%
Asian
4.00%
3.35%
0.47%
0.64%
0.01%
Other
12.55%
10.15%
3.61%
3.53%
0.45%
Chi-Square
55.65"*
42.7I"*
38.55"*
26.95***
1.67
Table shows proportion that report non-medical prescription drug use in the past year.
¡ I Î I ' I ' I I J I ¡ I ' '
(O.R. = 0.79) and Asiatis (O.R. = 0.57) are less likely to report use than Hispanics. Significant racial/ethnic differences persist for certain classes of prescription drug use once other forms of substance use are included in the model. Whites are more likely to report the nonmedical use of opiate-type pain relievers (O.R. = 1.36) and tranquilizers (O.R. = 2.13) than Hispanics. Black respondents are less likely to report the nonmedical use of tranquilizers (O.R. = 0.53) and stimulants (O.R. = 0.37) than Hispanics. Finally, Asians are less likely to report the nonmedical use of prescription opiate-type pain relievers (O.R. = 0.63) than Hispanics. In the complete model several of the controls are significantly associated with nonmedical prescription drug use. Males are less likely to report use than females. Respondents who rate their health as very good or excellent are less likely to report use than respondents who rate their health as either fair or poor. In addition, respondents without health insurance are more likely to report use than respondents with some form of health insurance. Not surprisingly, all three substance use measures are robust correlates of nonmedical prescription drug use. Respondents who report heavy episodic drinking in the past 30 days, or use marijuana or "hard" drugs in the past year are much more likely to report nonmedical prescription drug use. In an effort to gain a better understanding of nonmedical prescription drug use we replicated our regression models, for the nonmedical use of any prescription drug, with Hispanic respondents only (N = 6,062). Ideally we would have included measures known to be associated with substance use among Hispanics such as nativity, acculturation, culture, ethnicity, cultural change, and social and community relations (Warner et al, 2006), but the National Survey on Drug Use and Health does not adequately measure these concepts. We were, however, able to use
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FORD, RIVERA TABLE 3 BASELINE MODEL: RACE/ETHNICITY AND NONMEDICAL PRESCRIPTION DRUG USE Any Race/Ethnicity (Hispanic = REF) White
Black
Asian
Other
Gender (male)
Age (18-25)
Income ( $75,000
Pop. Den. (CBSA > 1 million = REF) CBSA < 1 million
Not in CBSA
Health (Fair/Poor =REF) Good Very Good
Excellent
Health Insurance (no coverage)
1.74*** (0.56) [0.08] 0.71** (-0.33) [0.09] 0.41*** (-0.89) [0.20] 1.42** (0.35) [0.11 1.03 (0.03) [0.04] 1.84*** (0.61) [0.04] 0.87* (-0.14) [0.05] 0.85* (-0.16) [0.07] 0.88 (-0.12) [0.07] . 1.03 (0.03) [0.04] 0.85 (-0.17) [0.09] 0.78* (-0.25) [0.11] 0.65*** (-0.42) [0.10] 0.43*** (-0.83) [0.11] 1.20*** (0.21) [0.04]
Pain
1.82*** (0.60) [0.09] 0.79** (-0.15) [0.10] 0.45*** (-0.80) [0.21] 1.46** (0.37) [0.12] 1.07 (0.07) [0.04] 1.76*** (0.58) [0.04] • 0.88* (-0.12) [0.06] 0.85* (-0.15) [0.08] 0.89 (-0.10) [0.08] . 1.06 (0.06) [0.05] 0.89 (-0.12) [0.08] 0.83 (-0.18) [0.11] 0.68*** (-0.38) [0.10] 0.43*** (-0.84) [0.12] 1.22*** (0.22) [0.05]
Tranquilizer
Stimulant
Sedative
3.19*** (1.16) [0.15] 0.47** (-0.75) [0.25] 0.24* (-1.45) [0.69] 2.02** (0.67) [0.24] 1.02 (0.02) [0.07] 2.57*** (0.96) [0.08]
1.92*** (0.66) [0.16] 0.29** (-1.24) [0.36] 0.43** (-1.21) [0.43] 1.79* (0.57) [0.23] 0.97 (-0.03) [0.07] 1.77*** (0.58) [0.09]
1.12 (0.10) [0.31] 0.60 (-0.54) [0.43] 0.15 (-1.90) [1.04] 0.86 (-0.19) [0.43] 1.14 (0.13) [0.19] 0.99 (0.03) [0.20]
0.89 (-0.11) [0.08] 0.88 (-0.12) [0.13] 0.96 (-0.02) [0.12]
0.84 (-0.17) [0.10] 0.80 (-0.21) [0.14] 1.04 (0.05) [0.12]
0.92 (-0.08) [0.24] 0.59 (-0.52) [0.29] 0.54* (-0.61) [0.30]
0.91 (-0.09) [0.09] 0.74* (-0.31) [0.15]
0.97 (-0.03) [0.08] 0.84 (-0.18) [0.18]
1.07 (0.06) [0.20] 0.82 (-0.19) [0.31]
0.63** (-0.45) [0.15] 0.51*** (-0.67) [0.15] 0.34*** (-1.08) [0.18] 1.63*** (0.49) [0.08]
0.89 (-0.11) [0.17] 0.74 (-0.29) [0.19] 0.52** (-0.66) [0.19] 1.28* (0.24) [0.10]
0.83 (-0.18) [0.28] 0.47* (-0.76) [0.33] 0.48 (-0.75) [0.39] 1.35 (0.20) [0.23]
Table includes odds ratio in bold type, with unstandardized regression coefficient in parentheses and standard error in brackets •p $75,000
1.00 0.93 0.95
1.02 0.94 0.96
1.05 0.99 1.07
0.99 0.88 1.17
1.00 0.63 0.58
Population Density CBSA > 1 million (reference) CBSA < 1 million Not in CBSA
1.09 1.10
1.12 1.15
0.96 1.01
. 0.99 1.15
1.06 0.99
Health Fair/poor (reference) Good Very good Excellent
0.92 0.80* 0.64**
0.98 0.84 0.64"
0.76 0.65* 0.59»
1.20 1.10 1.10
1.07 0.65 0.85
Health Insurance (no coverage)
1.17«
1.18"
1.57'"
1.18
1.30
Substance use Binge drinker Marijuana user Hard drug user
2.05'" 3.56*" 5.76"*
1.94"* 3.48"* 4.61*"
1.63"' 4.70"* 5.97"'
1.87"' 3.61'" 12.09'"
0.91 2.62" 8.12*"
•
Sedative
dimension of acculturation (Black & Markides, 1993; Caetano, 1987; Gil et al., 2000; Vega & Gil, 1999 ). In addition, other studies utilize language as an indicator of acculturation since it appears that language is a strong predictor of acculturation and it encompasses the majority of the variation in acculturation levels (Escobar & Vega, 2000; Turner & Marino, 1994). Prior research shows that Hispanics that are more acculturated are at greater risk for substance use than Hispanics with lower levels of acculturation (Amaro et al., 1990; Brook et al., 1998; Epstein et al., 2000; Marsiglia & Waller, 2002; Vega et al., 1998; Weite & Barnes, 1995). Findings for the regression models estimated for Hispanic respondents only are shown in Table 5. In the baseline model, older Hispanics are more likely to report use than younger Hispanics, and Hispanics who report being in very good WINTER 2008
297
FORD, RIVERA
or excellent health are less likely to report use than Hispanics in fair or poor health. Hispanics who completed the survey in Spanish are less likely to report nonmedical prescription drug use than Hispanics who completed the survey in English (O.R. = 0.50). In the complete model, Hispanic males are less likely to report nonmedical prescription drug use than females. As with the regression models that include all of the respondents, all of the substance use measures are significantly associated with nonmedical prescription drug use among Hispanics. DISCUSSION
The current research analyzes racial/ethnic differences in nonmedical prescription drug use with data from the 2005 National Survey on Drug Use and Health. The study findings indicate that there are significant racial/ethnic differences in nonmedical prescription drug use, providing support for our hypotheses. The results of the complete model clearly show that Whites are more likely to report use than Hispanics. The odds of reporting the nonmedical use of any prescription drug are 30% greater for Whites. Whites are also at increased odds for reporting the use of opiate-type pain relievers (36%) and stimulants (113%). However, Blacks and Asians are less likely to report nonmedical prescription drug use than Hispanics. The odds of reporting the nonmedical use of any prescription drug are 21% less for Blacks and 43% less for Asians. Blacks are also at decreased odds for reporting tranquilizers (47%) and stimulants (63%), while Asians are at decreased odds for reporting the use of opiate-type pain relievers (37%). These findings are supported by previous research examining racial/ethnic differences in other forms of substance use (Beauvais & Oetting, 2002; Johnston et al., 2006; Ma & Shive, 2000; Parker et al., 1995; Vega et al., 1993; Warner et al., 2006), which indicate that Hispanics are less likely to report use than Whites, but more likely to report use than Blacks or Asians. In addition to these racial/ethnic differences, a number of other variables are significantly associated with nonmedical prescription drug use. Females are at increased risk for nonmedical prescription drug use, a finding that is supported by prior research (Simoni-Wastila & Strickler, 2004; Simoni-Wastila et al, 2004; Sung et al., 2005). The overall health of the respondent is also associated with nonmedical prescription drug use. Respondents who report being in either very good or excellent health are less likely to report nonmedical prescription drug use than respondents who report being in either fair or poor health. In addition to health status, respondents without health insurance are also at increased risk for nonmedical prescription drug use. These findings suggest that some respondents may be using prescription drugs nonmedically to self-medicate existing physical and mental health problems and are supported by previous literature noting an association between physical/mental health 298
JOURNAL OF DRUG ISSUES
NONMEDICAL PRESCRIPTION DRUG USE AMONG HISPANICS TABLE 5 ANY NONMEDICAL PRESCRIPTION DRUG USE AMONG HISPANICS RESPONDENTS ONLY ( N = 6,062)
Gender (male)
Age (18-25)
Family income (< $20,000 = reO $20,000-$49,000
$50,000-$75,000
> $75,000
Baseline
Complete
0.95 (-0.06) [0.11] 1.79'** (0.58) [0.13]
0.65* (-0.43) [0.15] 1.14 (0.14) [0.15]
0.87
0.99
(-0.14) [0.15] 0.83 (-0.20) [0.25] 1.09 (0.08) [0.21]
(-0.01)
Pop. density (CBSA > 1 million = REF) CBSA < I million 1.18 (0.17) Not in CBSA
[0.14] 1.09 (0.09) [0.50]
Health (fiiir/poor = ref) good
0.80 (-0.22) [0.25] Very good 0.64* (-0.44) [0.23] Excellent 0.45*** (-0.79) [0.24] Health insurance (no coverage) 0.91 (-0.13) Survey conducted in Spanish
Heavy episodic drinker
Marijuaiia user
Hard drug user
[0.12] 0.50** (-0.68) [0.20]
[0.16] 0.87 (-0.15) [0.26] 1.12
(-0.11) [0.24] 1.12
(0.11) [0.14]
1.28 (0.25) [0.52] 0.88 (-0.13) [0.26] 0.72 (-0.33) [0.24] 0.60 (-0.50) [0.27] 0.99 (-0.07) [0.14] 0.98 (-0.01) [0.21] 1.91*** (0.65) [0.17] 3.13*** (1.14) [0.16] 6.02*** (1.80) [0.18]
Table includes odds ratio in bold type, with unstandaidized regression coefTicient in parentheses and standard error in brackets •p
