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We used the narrative vignette/storytelling approach to provide a holistic illustration of prescription stimulant misuse [PSM] and diversion [PSD] initiation and maintenance among college-attending emerging adults. We conducted 32 semi-structured, theory-guided interviews with 20 students during spring and summer 2019. The participants were diverse with respect to age, race/ethnicity and gender, and had a history of PSM and/or PSD. We created four narrative vignettes using a multi-step, collaborative process that incorporated patterns of what contributed to initiation and maintenance for four identified student groups (i.e., PSM with and without a prescription and PSD with and without a prescription). Characteristics of the individual, social and broader environments influenced behavior initiation, and positive reinforcement from trial behavior contributed to maintenance. Similarities and differences were identified across the groups. Approaches for PSM and PSD prevention and intervention in college-attending emerging adults should be multifaceted and consider prescription status.

Background We interviewed college students who engage in prescription stimulant misuse and diversion to better understand perspectives on prevention and intervention strategies. Methods Trained student researchers at one southern California university completed 32 face-to-face interviews with students who had a history of misuse and/or diversion. Participants provided insights on programs, policies, and practices that have the potential to deter behavior. Data were analyzed inductively via thematic analysis. Results Students were often misinformed or unaware of existing programs, policies and practices. Additionally, some students felt their behaviors would not be detected, whereas other students felt the fear of being detected would lead them to change their behaviors. Harm reduction and treatment-based approaches to address misuse were also recommended. Conclusions Our findings emphasize the importance of better educating students about, and enforcing, existing policies. In addition, the need to better inform students of existing campus programs is warranted.

INTRODUCTION: The misuse use of prescription stimulants (MPS) among college students is a pressing public health concern. Past research suggests there is variation in MPS frequency by race/ethnicity. According to the Theory of Triadic Influence (Flay et al., 2009), a health behavior can increase in frequency based on experiences and characteristics of the behavior. Thus, our aim was to examine the association between experiences and characteristics of MPS with MPS frequency, by race/ethnicity. METHODS: A probability sample of students attending two California universities completed a paper-based, psychometrically validated, instrument. Students who reported engaging in MPS in their lifetime were also asked questions about frequency, cost per pill, administration routes, sources, and experience with the drug. We used regression analyses to address our research questions, and conducted analyses by racial/ethnic group (i.e., for students identifying as Asian, Latinx, and White). RESULTS: MPS frequency did not vary by race/ethnicity. The influence of characteristics of misuse on frequency varied by race/ethnicity. Additionally, frequency of experiencing the desired outcome was significantly associated with increased MPS frequency across all three racial/ethnic groups. CONCLUSIONS: Characteristics of misuse are important to consider when screening for misuse and potential dependence. Particular attention should be given to these characteristics by race/ethnicity. Implications for future research are discussed.