Katie Angerhofer

HLTH 434
Annotated Bibliography

Research question: What is the relationship between social media exposure to pro-substance
content and subsequent usage of those substances among college students?

1) Mccabe, S. E., West, B. T., Teter, C. J., & Boyd, C. J. (2014). Trends in medical use,
diversion, and nonmedical use of prescription medications among college students from
2003 to 2013: Connecting the dots. Addictive Behaviors, 39(7), 1176-1182. Retrieved
from https://www.sciencedirect.com/science/article/pii/S030646031400 0732

The purpose of this study was to identify trends in demographics and background
characteristics among college age students of non-medical prescription opioid use.
This study was a mixed method study with both quantitative and qualitative questions
asked in a Web survey.
This study randomly selected college students to participate in a web survey, conducted
every other year.
The survey intended to measure the usage of non-medical opioids among college
students. Researchers were motivated to study this as non-medical usage of opioids increased
significantly from 1993-2001. Usage of non-medical opioids has shown more prevalent among
white Caucasian males who are members of social fraternities and sororities.
College students still in undergraduate programs were selected because the study focused
on gathering information specific to college student’s prescription opioid drug usage. Overall
respondent sample across the six-year study was 21,771 (56% female, 44% male).
Cross-sectional Web surveys, that were self-administered, were conducted in 2003, 2005,
2007, 2009, 2011, and 2013 at a large public four-year university in the Midwest United States.
Self-reported drug related activity through surveys has been shown highly reliable in many
outside studies
This study analyzed its data by computing the proportion of students who took the survey
that reported lifetime use of nonmedical prescription opioids. Pearson's chi-square test was also
used to examine past-year and life-time usage of opioids.
From the study it was concluded that approximately one in every five participants
reported nonmedical use of at least one prescription medication in their lifetime.
Limitations of the study that need to be considered are the results cannot be generalized
to all college aged students. This study was conducted in a large residential public top-tier
university that has primarily Caucasian students from middle to upper income families. Another
limitation is the potential bias of self-reporting nonmedical drug use behaviors, to address this
the survey explained participation was voluntary, confidential, and anonymous.
 2) Mccabe, S. E., Teter, C. J., Boyd, C. J., Knight, J. R., & Wechsler, H. (2005).
Nonmedical use of prescription opioids among U.S. college students: Prevalence and
correlates from a national survey. Addictive Behaviors, 30(4), 789-805. Retrieved from
https://www.sciencedirect.com/science/article/pii/S0306460304003028

The purpose of this study was to examine the prevalence of non-medical usage of
prescription opioids among college students in the U.S.
This study collected quantitative data.
This study was performed in 2001 when non-medical usage of prescription opioids was
increasing significantly. White males who attended college with rigorous admission programs
and earned lower grade point averages reported the highest rates of misuse. At the time of this
study 1 in 10 Americans between 18-25 reported nonmedical opiate usage.
College students were randomly selected from 119 different four-year colleges in 2001.
They were selected as they fit the criteria of being students in the U.S. 10,904 students
participated.
Self-reported surveys were distributed and reported previous to distribution to be valid
and reliable measures when confidentiality of responses is ensured. Scales of frequency of usage
was used on may questions in the survey.
Multi regression analyses were performed to measure likelihood of nonmedical use
among college students who were white, residents of social fraternities and sororities, attended
more competitive colleges, earned lower grade point averages and reported higher rates of risky
behavior. Statistical analysis of data was carried out using STATA software.
Among the population sampled the lifetime prevalence of nonmedical prescription
opioids was 12% and the past year prevalence was 7%. The study concludes with evidence that
non-medical use of prescription opioids is a problem on college campuses.
Limitations of this study include the failure to assess whether students misused their own
prescribed medications or someone else's medications. Another limitation was the lack of
gathering individual and contextual variables that may have affected reporting.

3) Meshesha, L. Z., Pickover, A. M., Teeters, J. B., & Murphy, J. G. (2017). A

Longitudinal Behavioral Economic Analysis of Non-medical Prescription Opioid Use
Among College Students. The Psychological Record, 67(2), 241-251. Retrieved from
https://link.springer.com/article/10.1007/s40732-017-0235-2

The purpose of this study was to identify theoretically based risk factors among young
adults for the use of non-medical prescription opioids. The goal of the study was also to support
the hypotheses that nonmedical prescription opioid use is associated with lower levels of
reinforcement from activities promoting substance-free living and lower consideration of the
future.
This study collected quantitative data.
Participants provided information regarding drug and alcohol use. They also completed
three measures to reinforce substance-free living. Participation was followed up 6 and 12 months
after initial participation. National trends of other nonmedical opioid usage studies held true for
this study that many using participants also reported marijuana and alcohol use.
In this study 71 undergraduate students participated. Undergraduates were selected as
they fit the age and student parameters for participation.
Questionnaires were used to collect individual use of drugs (including non-medical
opiates) and alcohol. Data on reported risky behaviors was also collected in the questionnaire.
The questionnaire had been adapted from other surveys and questionnaires collecting similar
data among similar populations and gave evidence of validity and reliability.
This study was analyzed with computer statistical analysis and regression models to
interpret data according to demographics.
From this study there was partial evidence that use of substances and non-medical opiates
are linked to a lack of future care and thinking and low levels of engagement in substance-free
reinforcement.
This study was limited by bias of limited participants and cannot be generalized to
all undergraduate students.

4) Arria, A. M., Caldeira, K. M., Vincent, K. B., O’Grady, K. E., & Wish, E. D. (2008).
Perceived Harmfulness Predicts Nonmedical Use of Prescription Drugs Among College
Students: Interactions with Sensation-Seeking. Prevention Science, 9(3), 191-201.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2574828/

This study aimed to examine the relationship between perceived risk/harmfulness and
subsequent nonmedical use of prescription drugs. It also explores the correlation between the
perceived harmfulness and non-medical use varied by level of sensation-seeking.
This study used mixed methods of obtaining data, both qualitative and quantitative.
Many studies have studied the correlation between drug use and sensation-seeking or
perceived harmfulness/risk, however, few studies have looked at both. This study looks at the
relationships of both as they correlate to each other and drug use. Many of the findings in this
study held consistent in similar studies. Prescription drugs were reported by most students as
having less of a risk than other drugs.
This study had 1,253 first year college students. College students were used because this
study was focused on the drug usage among college students. Late adolescence and young
adulthood are key times of drug initiation or formed drug habits, so first year college students
most accurately fit that age description.
 Personal interviews were conducted with each student and information regarding drug
use and sensation-seeking was gathered. Self-administered Zuckerman-Kuhlman Personality
Questionnaire-Short Forms (ZKPQ) were completed by participants. This form has shown
consistency (reliability) and validity in its usage.
Logistic regressions models were created to predict past year nonmedical prescription
drug use. Comparison analyses were used to examine relationship between perceived
harmfulness and drug use and sensation-seeking and drug use.
Study results discovered that one in four students perceived nonmedical prescription use
to be a great risk. As predicted low perceived harmfulness and high sensation-seekers were
associated with higher risk of non-medical drug use
A limitation of this study is that all participants came from one college and cannot be
generalized to all college students. Another limitation was that sensation-seeking was measured
prior to measurement of primary predictor variable, thus they were not measured concurrently.

5) Depue, J. B., Southwell, B. G., Betzner, A. E., & Walsh, B. M. (2015). Encoded
Exposure to Tobacco Use in Social Media Predicts Subsequent Smoking Behavior.
American Journal of Health Promotion, 29(4), 259-261. doi:10.4278/ajhp.130214-arb-
69

The purpose of this study was to identify possible links between smoking
habits/behaviors and exposure to social media and mass media depicting smoking.
This study used qualitative methods.
Respondents were asked if they had smoked a cigarette in the last 30 days and how many
times they saw cigarettes depicted on any media they were exposed to. They were also asked
about tobacco usage in the last 30 days and additional predictive tobacco use questions.
This study has 200 young adults from Connecticut aged 18-24 years participate. They
were selected because their age fit into the study’s parameters.
Data was collected from telephone surveys. Phone calls were made from computer
assisted telephone technology and electronic dialing of random digits from listed samples. The
questions had been adapted from previous valid and reliable phone surveys/interviews.
Logistic regressions were created to test the predictive social media exposure to cigarettes
and the likelihood of tobacco use.
Study results strongly suggest that social media exposure to tobacco related behavior is a
greater predictive factor of individual tobacco use than television depiction of tobacco.
This study was limited by response bias as it only reached those with telephones that
were young adults. It was also limited by geographic bias, only Connecticut residents responded
to the survey, so this cannot be generalized to the broad United States young adult population.
 6) Hanson, C. L., Cannon, B., Burton, S., & Giraud-Carrier, C. (2013). An Exploration of
Social Circles and Prescription Drug Abuse Through Twitter. Journal of Medical
Internet Research, 15(9). doi:10.2196/jmir.2741

The purpose of this study was to observe the social media behavior of suspected
prescription drug abusers reinforcing this behavior on Twitter with other suspected users.
This was a mixed methods study.
Data was collected from Nov 2011 to Nov 2012 and in that time 25 users were identified.
Of these 25 users’ social circles of 100 people were discovered for each user. Prescription drug
use has become the fastest growing drug problem in the U.S. over the last
25 Twitter users were identified as potential users and their accounts were followers and
posts analyzed. However, human involvement was not needed, posts were just observed to
identify behavioral risks of drug use.
Posts were tested for mention of drug use with tables formed with key words that would
suggest use or misuse of painkillers, depressants, stimulants, etc. Monitoring individual
conversations on Twitter has been shown in past studies as a valid way of identifying health
topics discussed on Twitter.
After running tests of words used in posts the occurrences of usage were analyzed to
determine the level of engagement in discussing the topic of prescription drug use.
From this study in the year of observing tweets 3,389,771 were identified as mentioning
prescription drugs (as determined by table of keywords). Those on Twitter observed to mention
drug abuse were surrounded by other users who also discussed it, thus likely reinforcing this
negative health behavior.
First limitation of this study is the chance of misspelled words that were filtered out or
missed. Also discussion of the topic does not inherently infer behavior of prescription drug use.
Another limitation is this study was limited by publicly available tweets and does not represent
private users or all Twitter users.

7) Hammond, A. S., Paul, M. J., Hobelmann, J., Koratana, A. R., Dredze, M., & Chisolm,
M. S. (2018). Perceived Attitudes About Substance Use in Anonymous Social Media
Posts Near College Campuses: Observational Study (Preprint).
doi:10.2196/preprints.9903

The purpose of this study was to observe the discussions of substance abuse on a social
media app near a college campus and behaviors/attitudes of drug abuse.
This was a qualitative study.
The social media app were posts were observed from was Yik-Yak which is an app
where users posts things that are shared with-in a 5 miles radius and users posts are completely
anonymous. Other studies have shown that self-reported drug abuse or attitudes toward drug use
are collected more reliably and are more valid when there is an element of anonymity.
 This study did not directly involve humans, it was an observational study that observed a
subset of 500 Yaks.
This study tested each post to determine the mention of drugs and the positive or negative
attitude toward that mention.
Posts were analyzed for mention of different substances, usage of substances, and attitude
toward the substance (positive or negative). These results were analyzed to develop quantitative
data of percentage of posts referring to positive usage of drugs.
From the observation of this study alcohol, marijuana, and tobacco were the top three
discussed substance topics. Posts around these topics were positive and reflected positive
attitudes toward the substances mentioned, unless the post mentioned abstinence from the
substance. Posts that mention others usage of the substance were negative.
A big limitation of this study was the anonymous nature of posts keeps us from knowing
the demographics of the posters including age, gender, status of student or not and whether the
user is real or an automated response.

8) Cabrera-Nguyen, E. P., Cavazos-Rehg, P., Krauss, M., Bierut, L. J., & Moreno, M. A.
(2016). Young Adults’ Exposure to Alcohol- and Marijuana-Related Content on
Twitter. Journal of Studies on Alcohol and Drugs, 77(2), 349-353.
doi:10.15288/jsad.2016.77.349

The purpose of this study was to examine the exposure the Twitter users have to alcohol
and marijuana related material and their subsequent use of those substances.
This was a mixed methods study.
Twitter is very popular among young adults and has a lot of influence on behaviors and
attitudes of its users. Facebook and MySpace have both been studied more that Twitter, so we
need research done on Twitter’s influence.
In this study 587 Twitter users between the age of 18-25 years were used. Of those 254
were men and 333 women. They were selected as they are the most common age users of Twitter
and are easily influenced by social media.
Online surveys were used to gather information on exposure to alcohol/tobacco depicted
posts on Twitter and their subsequent usage of the substances. The survey used has proven
reliable and valid in similar studies regarding social media influence on health behaviors and
attitudes.
This study conducted two multivariable logistic regression models to compare exposure
to pro- substance content and heavy drinking.
From this study there was a strong relationship between increased exposure to pro-
alcohol or marijuana content and increased usage of alcohol or marijuana. Results suggest that
more in depth research into exposure to pro- alcohol or marijuana content would be a great
foundation into prevention of substance usage by the users exposed to the content.
 This study is limited by the cross-sectional design because it makes causal inference
improbable.

9) Cavazos-Rehg, P. A., Krauss, M., Fisher, S. L., Salyer, P., Grucza, R. A., & Bierut, L. J.
(2015). Twitter Chatter About Marijuana. Journal of Adolescent Health, 56(2), 139-145.
doi:10.1016/j.jadohealth.2014.10.270

The purpose of this study was to examine the marijuana related posts among influential
Twitter users and the demographics of those users.
This was a mixed methods study.
Twitter has become very popular among young adults and influences from this app are
growing as research has observed. This study observed how tweets from influential users
mentioned marijuana use positively and influenced such things as legalizing marijuana and using
it for recreational and medical use.
Human subjects were not involved in this study. Influential users who posted pro-
marijuana content were observed.
Likert scales were used to create a sentiment code for evaluating tweets feelings toward
marijuana. This has been shown is similar studies as a very reliable and valid scale to use
measuring sentiment.
This study used the services of DemographicsPro to create a series of proprietary
algorithms to predict demographics of Twitter users based on Twitter usage/behavior.
From this study 7,653,738 tweets were observed discussing marijuana. In general, the
posts expressed positive attitudes towards marijuana and the personal use of the drug. It was also
observed the majority of pro-marijuana related posts were popular among African Americans
and young adults/youth.
Limitations of this study were that only public tweets and users were observed, and
influence was measured by number of followers and retweets but cannot infer actual influence.

10) Tibebu, S., Chang, V. C., Drouin, C., Thompson, W., & Do, M. T. (2018). At-a-glance
- What can social media tell us about the opioid crisis inCanada? Health Promotion
and Chronic Disease Prevention in Canada, 38(6), 263-267. doi:10.24095/hpcdp.38.6.08

The purpose of this study was to observe attitudes and behaviors as discussed social
media platforms specifically Twitter concerning opioid and prescription drug use. The study
wanted to observe attitudes of opioid crisis in Canada and attitudes towards the government's
response to the crisis.
This was a qualitative study.
In all of North America opioid related deaths has increased significantly in recent years.
In Canada alone from 2007 to 2016 opioid related deaths increased 30%. Canada’s government
has increased its efforts to address this issue, however, there are mixed responses to the
government's efforts. Twitter is a popular place for people, especially young adults to express
their attitudes and their predicted behaviors.
No human subjects were involved in this study. Twitter posts were observed from their
mention of key opioid related words.
Data was tested and collected by filtering messages from a random sample of tweets and filtering
posts that included a predetermined list of key words that indicated opioids. The company that
used this method has proven their methods reliable and valid in past studies carried out.
Data was collected and analyzed through Nexalogy (a social analytics company).
Regression models were created to compare reference to opioid usage and attitudes towards
opioids.
The results found that 2,602 tweets held key words, but that only 826 of those held strong
reference to opioid use. The results of this study suggest a benefit of creating public health
resources for Twitter and other social media users to have in dealing with the opioid crisis.
This study was limited by only public tweets available to filter through. Demographics
were also a limited in attaining from each post.