Personal, Social and Cultural Predictors of Intention to Misuse Prescription Stimulants among Medical Students: A Test of the Theory of Triadic Influence

Abstract

Objective

The misuse of prescription stimulants among students has been identified as a public health problem. To date, most research has focused on individual-level determinants of stimulant misuse, making research on the socio-cultural context of students’ misuse a priority. This study aims to test the applicability of the Theory of Triadic Influence, capturing three influence streams (personal, social and cultural) and three causational levels (ultimate, distal and proximal).

Method

A questionnaire on stimulant misuse was distributed among all bachelor’s and master’s students from the five Flemish medical faculties. In total, 3159 students participated (48.99% response rate). Data were analyzed using structural equation modeling.

Results

Multiple personal (i.e., fear of failure, procrastination, self-perceived ADHD, sensation-seeking, academic stress, controllability), social (i.e., living situation, peer endorsement, social norm) and cultural (i.e., competitive study-environment, financial worries, positive and negative expectancies, attitude) factors were identified as risk factors of misuse intention. The strongest ultimate to distal pathway was found between self-perceived ADHD and positive expectancies, meaning that students who believed they have ADHD, although not diagnosed, were more likely to have positive expectancies about stimulants. Moreover, the strongest distal to proximal pathways were found between expectancies and attitudes toward stimulant misuse (i.e., more positive and fewer negative expectancies were associated with more favorable attitudes). Finally, attitudes were most strongly related to misuse intention.

Conclusions

The current study shows that the TTI is an important framework to understand the risk factors of stimulant misuse among medical students. This study offers a strong basis for prevention initiatives.

Keywords:

• prescription stimulants
• misuse
• Theory of Triadic Influence
• determinants
• students
• enhancement
• socio-cultural context

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.

Ethics approval

The study was approved by the Ethics Committee of Social Sciences and Humanities of the University of Antwerp (file SHW_14_25_06) and the Medical Ethics Committee of the Ghent University Hospital (file 2016/0579).

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

Funding for this study was provided by grants from the Research Council of the University of Antwerp (grant number: 29706) and from the Research Foundation – Flanders (FWO) (grant number: 11B3517N). The funding sources had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.