Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.
University of Pittsburgh Medical Center, Pittsburgh, PA.
J Dev Behav Pediatr. 2021 Sep 1;42(7):540-552. doi: 10.1097/DBP.0000000000000923.
To describe the clinical and psychosocial characteristics, and their hypothesized interrelations, as it pertains to risk for stimulant diversion (sharing, selling, or trading) for adolescents in pediatric primary care treatment for attention-deficit/hyperactivity disorder.
Baseline data for 341 adolescents in a cluster-randomized controlled trial of stimulant diversion prevention in pediatric primary care (NCT_03080259) were used to (1) characterize diversion and newly measured risk factors, (2) examine their associations with age and sex, and (3) test whether associations among risk factors were consistent with model-implied predictions. Data were collected through multi-informant electronic surveys from adolescents and parents.
Diversion was rare (1%) in this sample (Mage = 15, SD = 1.5, 74% male participants). Older age was associated with being approached to divert (r = 0.25, p < 0.001) and higher risk on variables pertinent to stimulant treatment, such as treatment disclosure (r = 0.12, p < 0.05), tolerance for stimulant misuse and diversion (r = 0.17, p < 0.05), and peer norms favorable to stimulant misuse and diversion (r values = 0.15-0.34, p < 0.001). Sex differences were minimal. Variables from our conceptual model and specific to stimulants (e.g., perceived likelihood of negative consequences from diversion and schoolmate stimulant misuse/diversion) were related in multivariable regressions to hypothesized immediate precursors of diversion (e.g., diversion intentions).
Although diversion was rare for these primary care-treated adolescents, risk levels appear to be higher for older adolescents. Prevention may be most effective by capitalizing on current psychosocial strengths and discussing stimulant-specific attitudes, behaviors, and social norms before vulnerability to diversion increases in the final years of high school and into college.
描述青少年在儿科初级保健中接受注意力缺陷/多动障碍治疗时，与兴奋剂转用（分享、出售或交易）风险相关的临床和心理社会特征，以及它们的假设相互关系。
使用一项在儿科初级保健中进行兴奋剂转用预防的集群随机对照试验（NCT_03080259）的 341 名青少年的基线数据，（1）描述转用和新测量的风险因素，（2）检查它们与年龄和性别的关系，（3）测试风险因素之间的关系是否与模型隐含预测一致。数据通过多信息来源的电子调查从青少年和家长处收集。
在该样本中，转用现象罕见（1%）（Mage = 15，SD = 1.5，74%的男性参与者）。年龄较大与被诱导向转用（r = 0.25，p < 0.001）和与兴奋剂治疗相关的变量（如治疗披露）的更高风险有关（r = 0.12，p < 0.05），以及对兴奋剂滥用和转用的容忍度（r = 0.17，p < 0.05）和对兴奋剂滥用和转用的同伴规范（r 值 = 0.15-0.34，p < 0.001）。性别差异很小。来自我们概念模型的、与兴奋剂相关的变量（例如，转用可能产生的负面后果的感知可能性）以及与兴奋剂转用相关的特定变量（例如，转用意图）在多元回归中与转用的假设直接前体相关。
尽管这些在初级保健中接受治疗的青少年中，转用现象罕见，但对于年龄较大的青少年，风险水平似乎更高。通过利用当前的心理社会优势，并在易受转用的风险增加之前，讨论兴奋剂的具体态度、行为和社会规范，可能会使预防最有效，这种风险增加发生在高中的最后几年和大学阶段。
