Journal of Pharmacy Practice http://jpp.sagepub.com/
Stress, Drugs, and Alcohol Use Among Health Care Professional Students: A Focus on Prescription Stimulants Monica K. Bidwal, Eric J. Ip, Bijal M. Shah and Melissa J. Serino Journal of Pharmacy Practice published online 14 August 2014 DOI: 10.1177/0897190014544824 The online version of this article can be found at: http://jpp.sagepub.com/content/early/2014/08/12/0897190014544824
Published by: http://www.sagepublications.com
On behalf of:
New York State Council of Health-system Pharmacists
Additional services and information for Journal of Pharmacy Practice can be found at: Email Alerts: http://jpp.sagepub.com/cgi/alerts Subscriptions: http://jpp.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> OnlineFirst Version of Record - Aug 14, 2014 What is This?
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Research Article
Stress, Drugs, and Alcohol Use Among Health Care Professional Students: A Focus on Prescription Stimulants
Journal of Pharmacy Practice 1-8 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0897190014544824 jpp.sagepub.com
Monica K. Bidwal, PharmD1, Eric J. Ip, PharmD, BCPS, CSCS, CDE1, Bijal M. Shah, BPharm, PhD1, and Melissa J. Serino, PharmD1
Abstract Objective: To contrast the characteristics of pharmacy, medicine, and physician assistant (PA) students regarding the prevalence of drug, alcohol, and tobacco use and to identify risk factors associated with prescription stimulant use. Participants: Five hundred eighty nine students were recruited to complete a 50-item Web-based survey. Main Outcome Measures: Demographics, nonmedical prescription medication use, illicit drug and alcohol use, Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR) psychiatric diagnoses, and perceived stress scale (PSS) scores. Results: Medicine and PA students reported greater nonmedical prescription stimulant use than pharmacy students (10.4% vs 14.0% vs 6.1%; P < .05). Medicine and PA students were more likely to report a history of an anxiety disorder (12.1% vs 18.6% vs 5.9%; P < .05), major depressive disorder (9.4% vs 8.1% vs 3.3%; P < .05), and attention-deficit hyperactivity disorder (ADHD; 4.0% vs 9.3% vs 0.7%; P < .001) than pharmacy students. PSS scores for all 3 groups (21.9-22.3) were roughly twice as high as the general adult population. Conclusion: Illicit drug and prescription stimulant use, psychiatric disorders, and elevated stress levels are prevalent among health care professional students. Health care professional programs may wish to use this information to better understand their student population which may lead to a reassessment of student resources and awareness/prevention programs. Keywords prescription medication misuse, abuse, stimulants, medical professional students
The misuse of prescription medications is not a new phenomenon; during World War II, prescription stimulants were widely consumed by the armed forces and industrial workers to enhance alertness.1 A reported 25 million individuals worldwide used amphetamines in 2004, and approximately 1 in 10 Americans between the ages of 18 and 25 reported nonmedical use of opiate analgesics.1,2 Nonmedical use of prescription medications is a growing concern among undergraduate college students in the United States and has been reported in multiple national surveys. Monitoring the future stated that misuse of prescription medications by college students was at the highest level in 2004, and rates have remained steady since 2006.3 According to the National Survey on Drug Use and Health 2012, adults 18 to 25 years old had the highest prevalence of illicit prescription drug use among all age-groups surveyed.2 Prescription opioid analgesics and stimulants were among the most widely misused medications among this age-group.2-4 Prescription drug use and diversion represents a significant problem among undergraduate college students.3-9 There is limited information about these types of behaviors among health care professional students. Prior studies have primarily analyzed trends at a single institution or a few programs across 1 state.4,10 As health care professional students will
likely have influence on patient health outcomes in the future, the presence of such behaviors may potentially affect the quality and type of care they provide to their patients. Of note, prescription opioid analgesics and stimulants are the most commonly misused medications among pharmacists and nurses.10 The purpose of this study is to contrast the characteristics of 3 groups of health care professional students in California: pharmacy (Doctor of Pharmacy), medicine (Doctor of Medicine/Doctor of Osteopathic Medicine), and physician assistant (PA) regarding drug, alcohol, and tobacco use and to identify risk factors associated with prescription stimulant use. To our knowledge, this study represents the first multischool and multidisciplinary comparison among these groups of future health care professionals.
1
Department of Pharmacy Practice, Touro University College of Pharmacy, Vallejo, CA, USA Corresponding Author: Monica K. Bidwal, Department of Pharmacy Practice, Touro University College of Pharmacy, 13010 Club Dr, Vallejo, CA 94592, USA. Email: [email protected]
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on December 7, 2014
2
Journal of Pharmacy Practice
Methods Health care professional students attending pharmacy school, medical school, or a PA program in California with Internet access who received the e-mail announcement were included in the study. The following subjects were excluded from the study: health care professional students without Internet access or who did not receive the e-mail announcement; individuals who opened and viewed the survey link but decided not to participate; and individuals who began but did not complete the survey. A 50-item Web-based survey, administered through Qualtrics Labs Inc (Provo, Utah), was used to assess several characteristics of health care professional students. Specific variables assessed included the following: demographics; lifestyle/study habits; prescription stimulant use, motivations for its use, and acquisition history; use of other medications, illicit drugs, tobacco, and alcohol; Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) psychiatric conditions diagnosed by a health care professional; and perceived stress scale (PSS). The PSS is a validated psychological instrument that measures the degree to which situations in one’s life are appraised as stressful. There are 10 questions based on a 0- to 4-point scale that asks about feelings and thoughts during the last month to measure perceptions of stress.11
as mean + standard deviation. The Pearson’s chi-square test and analysis of variance were used for comparisons of categorical and continuous data, respectively. The Bonferroni test was used for comparisons of variables with equal variances, while the Games-Howell test was used for comparisons of variables with unequal variances. Logistic regression analysis was used to identify the risk factors for nonmedical use of prescription stimulants. A P value of less than .05 was considered a statistically significant difference.
Results When the survey closed on April 15, 2011, there were 730 survey attempts. Among these, 103 were excluded for filling out an incomplete survey, 11 did not disclose which health care professional program they attended, and an additional 27 were excluded for attending other programs not specified in the inclusion criteria (3—Pre-Pharmacy, 17—Masters of Public Health, 1—Education, and 6—other). This resulted in a final analytical cohort of 589 subjects who fully completed and submitted a valid survey. A total of 309 pharmacy, 173 medicine, and 107 PA students were included in this analysis.
Demographics Data Collection and Data Security Participants were recruited via e-mail between February 15 to April 15, 2011. The Associate Dean of Student Affairs or program coordinator of each pharmacy, medical, and PA school in California was contacted to obtain consent for student participation. Of the 27 schools contacted, 5 of the 8 pharmacy (3 private and 2 public) schools, 2 of the 10 medical (1 private and 1 public) schools, and 5 of the 9 PA (4 private and 1 public) programs agreed to allow student participation. Students were contacted via e-mail through their Associate Dean of Student Affairs or program coordinator with a description of the study and directions to access the online survey Weblink using Qualtrics. One additional reminder was sent to the students 21 days after the initial start date of the study. The survey Weblink directed potential subjects to an informed consent page providing additional information regarding the study and assuring confidentiality and anonymity. No individually identifiable data were collected, Internet provider addresses were not logged, and data transfer was encrypted. All researchers had previously completed a National Institutes of Health human subjects training program. The study received institutional review board approval from Touro University, California.
Statistical Methods All statistical analyses were conducted using SPSS for Windows version 14. Since the survey was primarily descriptive in nature, categorical data were reported as frequency and percentages of respondents, and continuous data were reported
The demographic data comparing pharmacy, medicine, and PA students are summarized in Table 1. Pharmacy students were approximately 1 year younger than medicine and PA students (26.4 vs 27.2 vs 27.6, P ¼ .016). The majority of pharmacy, medicine, and PA students were female (71.5% vs 59% vs 78.5%, respectively, P ¼ .001) and never married (84.1% vs 67.4% vs 64.5% respectively, P < .001). Although the largest proportion of both medicine and PA students were caucasian (64.7% and 65.4%), the largest proportion of the pharmacy students were Asian or Pacific Islander (53.1%). Most students were in their didactic portion of their curriculum as opposed to clinical rotations. Pharmacy students were more likely than medicine and PA students to be in a fraternity/sorority (29.0% vs 14.5% vs 2.8%, respectively, P < .001). Regarding study habits, the majority of pharmacy, medicine, and PA students reported procrastinating in their studies (79.9% vs 80.3% vs 73.8%, respectively, P ¼ .360). Pharmacy, medicine, and PA students all averaged less than 7 hours of sleep (6.6 vs 6.8. vs 6.9 hours, respectively, P ¼ .004). During examination periods, pharmacy students reported the least amount of sleep (4.9 hours) compared to medicine or PA (5.8 vs 5.4 hours respectively, P < .001). Medicine students reported seeing their primary care provider for annual check-ups less frequently than both pharmacy and PA students (39.5% vs 48.9% vs 58.7%, respectively, P ¼ .008). There were no significant differences between the 3 groups regarding reported history of physical abuse. However, medicine and PA students were more than 4 times as likely to report a history of sexual abuse than the pharmacy students (11.0% vs 11.2%, 2.6%, respectively, P < .001). Similarly, medicine and PA students were more likely to report having a primary
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on December 7, 2014
Bidwal et al
3
Table 1. Demographics and Background. Pharmacy (n ¼ 309) Demographics Current age, Mean + SD, y Gender, no. (%) of respondents Female Male Race, no. (%) of respondents Asian or Pacific Islander American Indian or Alaskan Native Black, not of Hispanic origin Hispanic White, not of Hispanic origin Other Marital status, no. (%) of respondents Never married Married Separated/divorced Institution, no. (%) of respondents Type of institution Private Public Full time or part time Full time Part time Portion of program, no. (%) of respondents Didactic Rotations Live off or on-campus, no. (%) of respondents On-campus Off-campus Fraternity/sorority, no. (%) of respondents Yes No Year in school, no. (%) of respondents First year Second year Third year Fourth year Other GPA (4.0 scale), no. (%) of respondents
Stress, Drugs, and Alcohol Use Among Health Care Professional Students: A Focus on Prescription Stimulants Monica K. Bidwal, Eric J. Ip, Bijal M. Shah and Melissa J. Serino Journal of Pharmacy Practice published online 14 August 2014 DOI: 10.1177/0897190014544824 The online version of this article can be found at: http://jpp.sagepub.com/content/early/2014/08/12/0897190014544824
Published by: http://www.sagepublications.com
On behalf of:
New York State Council of Health-system Pharmacists
Additional services and information for Journal of Pharmacy Practice can be found at: Email Alerts: http://jpp.sagepub.com/cgi/alerts Subscriptions: http://jpp.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> OnlineFirst Version of Record - Aug 14, 2014 What is This?
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on December 7, 2014
Research Article
Stress, Drugs, and Alcohol Use Among Health Care Professional Students: A Focus on Prescription Stimulants
Journal of Pharmacy Practice 1-8 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0897190014544824 jpp.sagepub.com
Monica K. Bidwal, PharmD1, Eric J. Ip, PharmD, BCPS, CSCS, CDE1, Bijal M. Shah, BPharm, PhD1, and Melissa J. Serino, PharmD1
Abstract Objective: To contrast the characteristics of pharmacy, medicine, and physician assistant (PA) students regarding the prevalence of drug, alcohol, and tobacco use and to identify risk factors associated with prescription stimulant use. Participants: Five hundred eighty nine students were recruited to complete a 50-item Web-based survey. Main Outcome Measures: Demographics, nonmedical prescription medication use, illicit drug and alcohol use, Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR) psychiatric diagnoses, and perceived stress scale (PSS) scores. Results: Medicine and PA students reported greater nonmedical prescription stimulant use than pharmacy students (10.4% vs 14.0% vs 6.1%; P < .05). Medicine and PA students were more likely to report a history of an anxiety disorder (12.1% vs 18.6% vs 5.9%; P < .05), major depressive disorder (9.4% vs 8.1% vs 3.3%; P < .05), and attention-deficit hyperactivity disorder (ADHD; 4.0% vs 9.3% vs 0.7%; P < .001) than pharmacy students. PSS scores for all 3 groups (21.9-22.3) were roughly twice as high as the general adult population. Conclusion: Illicit drug and prescription stimulant use, psychiatric disorders, and elevated stress levels are prevalent among health care professional students. Health care professional programs may wish to use this information to better understand their student population which may lead to a reassessment of student resources and awareness/prevention programs. Keywords prescription medication misuse, abuse, stimulants, medical professional students
The misuse of prescription medications is not a new phenomenon; during World War II, prescription stimulants were widely consumed by the armed forces and industrial workers to enhance alertness.1 A reported 25 million individuals worldwide used amphetamines in 2004, and approximately 1 in 10 Americans between the ages of 18 and 25 reported nonmedical use of opiate analgesics.1,2 Nonmedical use of prescription medications is a growing concern among undergraduate college students in the United States and has been reported in multiple national surveys. Monitoring the future stated that misuse of prescription medications by college students was at the highest level in 2004, and rates have remained steady since 2006.3 According to the National Survey on Drug Use and Health 2012, adults 18 to 25 years old had the highest prevalence of illicit prescription drug use among all age-groups surveyed.2 Prescription opioid analgesics and stimulants were among the most widely misused medications among this age-group.2-4 Prescription drug use and diversion represents a significant problem among undergraduate college students.3-9 There is limited information about these types of behaviors among health care professional students. Prior studies have primarily analyzed trends at a single institution or a few programs across 1 state.4,10 As health care professional students will
likely have influence on patient health outcomes in the future, the presence of such behaviors may potentially affect the quality and type of care they provide to their patients. Of note, prescription opioid analgesics and stimulants are the most commonly misused medications among pharmacists and nurses.10 The purpose of this study is to contrast the characteristics of 3 groups of health care professional students in California: pharmacy (Doctor of Pharmacy), medicine (Doctor of Medicine/Doctor of Osteopathic Medicine), and physician assistant (PA) regarding drug, alcohol, and tobacco use and to identify risk factors associated with prescription stimulant use. To our knowledge, this study represents the first multischool and multidisciplinary comparison among these groups of future health care professionals.
1
Department of Pharmacy Practice, Touro University College of Pharmacy, Vallejo, CA, USA Corresponding Author: Monica K. Bidwal, Department of Pharmacy Practice, Touro University College of Pharmacy, 13010 Club Dr, Vallejo, CA 94592, USA. Email: [email protected]
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on December 7, 2014
2
Journal of Pharmacy Practice
Methods Health care professional students attending pharmacy school, medical school, or a PA program in California with Internet access who received the e-mail announcement were included in the study. The following subjects were excluded from the study: health care professional students without Internet access or who did not receive the e-mail announcement; individuals who opened and viewed the survey link but decided not to participate; and individuals who began but did not complete the survey. A 50-item Web-based survey, administered through Qualtrics Labs Inc (Provo, Utah), was used to assess several characteristics of health care professional students. Specific variables assessed included the following: demographics; lifestyle/study habits; prescription stimulant use, motivations for its use, and acquisition history; use of other medications, illicit drugs, tobacco, and alcohol; Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) psychiatric conditions diagnosed by a health care professional; and perceived stress scale (PSS). The PSS is a validated psychological instrument that measures the degree to which situations in one’s life are appraised as stressful. There are 10 questions based on a 0- to 4-point scale that asks about feelings and thoughts during the last month to measure perceptions of stress.11
as mean + standard deviation. The Pearson’s chi-square test and analysis of variance were used for comparisons of categorical and continuous data, respectively. The Bonferroni test was used for comparisons of variables with equal variances, while the Games-Howell test was used for comparisons of variables with unequal variances. Logistic regression analysis was used to identify the risk factors for nonmedical use of prescription stimulants. A P value of less than .05 was considered a statistically significant difference.
Results When the survey closed on April 15, 2011, there were 730 survey attempts. Among these, 103 were excluded for filling out an incomplete survey, 11 did not disclose which health care professional program they attended, and an additional 27 were excluded for attending other programs not specified in the inclusion criteria (3—Pre-Pharmacy, 17—Masters of Public Health, 1—Education, and 6—other). This resulted in a final analytical cohort of 589 subjects who fully completed and submitted a valid survey. A total of 309 pharmacy, 173 medicine, and 107 PA students were included in this analysis.
Demographics Data Collection and Data Security Participants were recruited via e-mail between February 15 to April 15, 2011. The Associate Dean of Student Affairs or program coordinator of each pharmacy, medical, and PA school in California was contacted to obtain consent for student participation. Of the 27 schools contacted, 5 of the 8 pharmacy (3 private and 2 public) schools, 2 of the 10 medical (1 private and 1 public) schools, and 5 of the 9 PA (4 private and 1 public) programs agreed to allow student participation. Students were contacted via e-mail through their Associate Dean of Student Affairs or program coordinator with a description of the study and directions to access the online survey Weblink using Qualtrics. One additional reminder was sent to the students 21 days after the initial start date of the study. The survey Weblink directed potential subjects to an informed consent page providing additional information regarding the study and assuring confidentiality and anonymity. No individually identifiable data were collected, Internet provider addresses were not logged, and data transfer was encrypted. All researchers had previously completed a National Institutes of Health human subjects training program. The study received institutional review board approval from Touro University, California.
Statistical Methods All statistical analyses were conducted using SPSS for Windows version 14. Since the survey was primarily descriptive in nature, categorical data were reported as frequency and percentages of respondents, and continuous data were reported
The demographic data comparing pharmacy, medicine, and PA students are summarized in Table 1. Pharmacy students were approximately 1 year younger than medicine and PA students (26.4 vs 27.2 vs 27.6, P ¼ .016). The majority of pharmacy, medicine, and PA students were female (71.5% vs 59% vs 78.5%, respectively, P ¼ .001) and never married (84.1% vs 67.4% vs 64.5% respectively, P < .001). Although the largest proportion of both medicine and PA students were caucasian (64.7% and 65.4%), the largest proportion of the pharmacy students were Asian or Pacific Islander (53.1%). Most students were in their didactic portion of their curriculum as opposed to clinical rotations. Pharmacy students were more likely than medicine and PA students to be in a fraternity/sorority (29.0% vs 14.5% vs 2.8%, respectively, P < .001). Regarding study habits, the majority of pharmacy, medicine, and PA students reported procrastinating in their studies (79.9% vs 80.3% vs 73.8%, respectively, P ¼ .360). Pharmacy, medicine, and PA students all averaged less than 7 hours of sleep (6.6 vs 6.8. vs 6.9 hours, respectively, P ¼ .004). During examination periods, pharmacy students reported the least amount of sleep (4.9 hours) compared to medicine or PA (5.8 vs 5.4 hours respectively, P < .001). Medicine students reported seeing their primary care provider for annual check-ups less frequently than both pharmacy and PA students (39.5% vs 48.9% vs 58.7%, respectively, P ¼ .008). There were no significant differences between the 3 groups regarding reported history of physical abuse. However, medicine and PA students were more than 4 times as likely to report a history of sexual abuse than the pharmacy students (11.0% vs 11.2%, 2.6%, respectively, P < .001). Similarly, medicine and PA students were more likely to report having a primary
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on December 7, 2014
Bidwal et al
3
Table 1. Demographics and Background. Pharmacy (n ¼ 309) Demographics Current age, Mean + SD, y Gender, no. (%) of respondents Female Male Race, no. (%) of respondents Asian or Pacific Islander American Indian or Alaskan Native Black, not of Hispanic origin Hispanic White, not of Hispanic origin Other Marital status, no. (%) of respondents Never married Married Separated/divorced Institution, no. (%) of respondents Type of institution Private Public Full time or part time Full time Part time Portion of program, no. (%) of respondents Didactic Rotations Live off or on-campus, no. (%) of respondents On-campus Off-campus Fraternity/sorority, no. (%) of respondents Yes No Year in school, no. (%) of respondents First year Second year Third year Fourth year Other GPA (4.0 scale), no. (%) of respondents
