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Cumulative protective factors are associated with decreased risk for prescription opioid misuse among high school students
  1. Zach Timpe1,
  2. Heather B Clayton2,
  3. Jack Andrzejewski3,
  4. Chanel Phillips4,
  5. Sarah Conklin5,
  6. Michele K Bohm6
  1. 1ICF, Atlanta, GA, USA
  2. 2Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  3. 3Health Behavior, San Diego State University-University of California, San Diego Joint Doctoral Program in Public Health, San Diego, California, USA
  4. 4Oak Ridge Associated Universities, Atlanta, Georgia, USA
  5. 5Virginia Department of Health, Richmond, Virginia, USA
  6. 6Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Dr Zach Timpe, ICF, Atlanta, GA 30329, USA; zach.timpe{at}


Background Multiple protective factors at the individual and environmental levels have been associated with prescription opioid misuse (POM) among adolescents. The literature may benefit by extending this research to consider the association between cumulative protective factors and current (ie, within the past 30 days) POM.

Methods The 2017 Virginia Youth Survey (part of the Youth Risk Behaviour Surveillance System) (N=3697) was used to investigate recent POM and the presence of individual and cumulative protective factors among high school students. Youth were asked to indicate whether they had engaged POM within the past 30 days. A set of protective factors representing youths’ internal assets (eg, aspirational plans for education) and external resources (eg, family meals, safe school environment) were investigated as predictors of current POM, followed by testing of a cumulative protective factor score. Logistic regression models estimated ORs and 95% CIs.

Results When including demographics and risk factors in the model, none of the individual protective factors were significantly associated with current POM. Alternatively, the cumulative protective factor score was significantly associated with a decrease in the odds of current POM.

Conclusions The cumulative protective factor score was significantly associated with a decrease in the odds of current POM among high school students in Virginia. Programmes designed to provide multiple forms of support may be effective strategies for preventing current POM.

  • health promotion
  • surveillance
  • social factors in
  • drug misuse

Statistics from


  • Contributors ZT, HBC and JA conceptualised the study. ZT wrote the introduction and discussion sections with critical input from all coauthors. HBC and JA carried out statistical analyses and wrote the methods and results sections. MKB provided critical reviews of all materials. SC provided expert advice regarding the use of Virginia data. CP contributed editing and conceptual planning for the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Data are not available to the public for general use.

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