An Exploratory Multilevel Analysis of Nonprescription Stimulant Use in a Sample of College Students

Nonprescription stimulant use is a high-risk behavior prevalent in the college population. To date, research on this substance use behavior lacks a comprehensive theoretical lens as well as geographical diversity. Guided by the Theory of Triadic Influence (TTI), multilevel (i.e., students within schools) modeling was used to analyze survey data from the Spring 2009 American College Health Association-National College Health Assessment II. We hypothesized that the behavior would be associated with ultimate underlying causes, distal predisposing influences, proximal immediate predictors, and immediate precursors found in the TTI's three streams of influence (i.e., intrapersonal, social situation/ context, and sociocultural environment). In our sample (N = 10,220 students; 18 schools), the mean prevalence of past-year use of prescription stimulants without a prescription was 10.70% (range across schools, 0.33%-20.04%). Our hypothesis regarding the multifaceted nature of the predictors of the behavior was supported. Implications for prevention efforts, limitations, and future research directions are discussed.