Date of Award

Spring 5-11-2018

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Health

First Advisor

Sheryl Strasser, PhD

Second Advisor

Ashli Owen-Smith, PhD

Third Advisor

Michael Huey, MD


Background: Despite national attention on opioid abuse, little is known about opioid misuse (OM; defined as heroin use or non-medical use of opioid prescription drugs) among students pursuing higher education in the United States. A better understanding of student OM is necessary to inform a public health process to develop campus-specific prevention strategies and interventions. This dissertation examined three main questions: 1) what individual, social and institutional characteristics are associated with OM, 2) Is OM elevated among student service members/veterans, and 3) whether OM is associated with comorbidities including mental and physical diagnoses, sleep, and suicidality, as well as whether the effect of OM on suicidality is mediated by its effects on sleep quality?

Methods: Data were from full-time students (N = 91,322) enrolled at 103 institutions that participated in the spring 2015 American College Health Association–National College Health Assessment survey. Multilevel modeling and binary logistic regression were used to examine associations between individual, social, and school-level predictors and OM.

Results: The prevalence of opioid misuse was 7% (N = 6,376). OM was associated with several individual, social and institutional characteristics, such as being an undergraduate versus graduate student (OR = 1.26, 95% CI = [1.179, 1.348]). Analyses showed that being a student service member/veteran (SSM/V) who had served in hazardous duty increased the odds of OM by roughly 31% (OR = 1.309, 95% CI = 1.113, 1.539). Likewise, students who reported misusing opioids were twice as likely to report having suicidal ideation or a past suicide attempt (OR = 2.317, 95% CI = [2.193, 2.448]), and a number of other health outcomes, such as chronic illness, anxiety, and depression. Mediation analyses in MPlus showed that sleeping difficulties partially mediated the relationship between OM and suicidality.

Conclusion: OM has devastating economic, social and medical consequences for individuals and communities. Significant associations between individual characteristics, comorbid conditions, and social environmental structures and OM among students in higher education highlight the need to illuminate other risk and protective factors as well as to identify effective clinical and environmental interventions to reduce harm and save lives on campus.