Gender Differences in Nonprescribed Psychostimulant Use in Young Adults.

BACKGROUND: In order to better understand the recent rise in nonprescribed use of psychostimulants on college campuses, motives, outcomes, and acceptability of nonprescribed psychostimulants have been evaluated. Despite knowledge that students use nonprescribed medical stimulants for improved academic performance and recreational use, gender differences in these motives have not been examined, despite the fact that the social construction of gender may well affect motives for use. OBJECTIVES: The goal of the present study was to examine gender differences in motives, outcomes, and acceptability of nonprescribed psychostimulant use. METHODS: 2716 undergraduates (1448 male) between the ages of 17 and 57 years (M = 19.43 years, SD = 1.7 years) completed an online survey examining subjective motives of nonprescribed psychostimulant use, as well as behaviors after use and moral views of nonprescribed use. RESULTS: Consistent with hypotheses and known gender differences in social motivation, results suggested that while females are more likely to use nonprescribed psychostimulants for reasons related to schoolwork, males are typically more likely to use psychostimulants for reasons related to partying and socializing. Additional gender differences were that males are more likely to take part in other risky behaviors after use of psychostimulants, as well as view nonprescribed use as more moral and less physically dangerous than females. Conclusions/Importance: This work suggests that there are striking gender differences in motivation and outcomes of use of nonprescribed psychostimulants, which may have implications for personalized approaches for prevention of nonprescribed psychostimulant use on campuses based on gender.

Subjective Report of Side Effects of Prescribed and Nonprescribed Psychostimulant Use in Young Adults.

BACKGROUND: Side effects of prescribed and nonprescribed psychostimulant use are understudied. OBJECTIVES: The study examined side effects of prescribed and nonprescribed psychostimulant use in a college sample with attention to possible gender differences. METHODS: 2716 undergraduates (1448 male) between the ages of 17 and 57 years (M = 19.43 years, SD = 1.7 years) completed an online survey that included questions about the subjective side effects of prescribed and nonprescribed psychostimulant use. RESULTS: Results suggested that prescribed users more frequently reported side effects, compared to nonprescribed users. For prescribed users, females more frequently reported appetite, somatic, and anxiety-related side effects compared to males. For nonprescribed users, while females reported more somatic and anxiety-related side effects, males more frequently reported loss of sex drive and sweating as side effects. Conclusions/Importance: These findings suggest prescribed users of psychostimulants more frequently report side effects with prominent gender differences in line with gender roles.

The four Cs of physician leadership: A key to academic physician success.

Leadership is increasingly recognized as important in medicine. Physician leadership impacts healthcare delivery and quality. Little work has been done to determine how physician leadership in practice aligns with established models in leadership theory. We conducted 40 semi-structured, 50-minute interviews of physicians who had achieved the rank of professor in our school of medicine and were serving, or had served, in leadership positions. We used an inductive content analysis approach to identify content categories, with leadership emerging as one such category. Subsequently, for the present study, we performed a secondary analysis of the data. To do this, we reviewed all transcripts, seeking to identify if and how participants discussed leadership in relation to success in academic medicine. Following identification of sub-categories related to leadership, we performed qualitative content analysis. We then used a deductive content analysis approach to determine how participants' discussions of leadership aligned with major leadership theories. Then, the principal investigator conducted a secondary inductive content analysis revealing leadership themes that were synthesized into a new model of physician leadership. Twenty-nine participants spontaneously discussed leadership and leadership-related topics as important to their own academic success and comprised the present study cohort. Participants identified contributors to leadership success that aligned with multiple major leadership theories, including leadership traits, skills, behaviors styles, and situational leadership. None of the leadership theories aligned completely with our physician leaders' discussions, suggesting an alternate leadership framework was operating. Further analysis revealed a new model of leadership comprised of the "Four Cs of Physician Leadership": character, competence, caring, and communication. Our participant group of academic physicians identified leadership capabilities as being important in their academic success. While they discussed leadership in ways that fit to varying degrees with the major leadership theories, their discussions revealed a novel, more holistic leadership framework. Further work will be beneficial to determine if this model of leadership is specific to physicians or is more generalizable.

Illegal college ADHD stimulant distributors: characteristics and potential areas of intervention.

This study identifies indicators of college students, with prescriptions to Attention Deficit Hyperactivity Disorder (ADHD) stimulants, who are most likely to distribute their medication to nonprescribed peers. 2,313 undergraduate students at a large Southeastern University were surveyed from 2009 to 2011. 5.2% (n = 120) were currently taking a prescribed ADHD stimulant. Analyses revealed that distributors are more likely to (1) take their medication less frequently; (2) misuse their stimulants for "off label" purposes; (3) be a member of a fraternity; (4) overestimate the percentages of users; and (5) belong to at-risk peer groups. The work concludes by discussing the study's implications, limitations and future research.

"Adderall is definitely not a drug": justifications for the illegal use of ADHD stimulants.

In-depth interviews were conducted in 2007 with 175 undergraduate students (94 males, 81 females, 13 non-Caucasian) at a large, public southeastern research university located in an urban area in the United States. Our primary goal was to identify how these students conceive of Attention Deficit Hyperactivity Disorder (ADHD) stimulants and their illegal use. We discovered that these students frame stimulant use as both physically harmless and morally acceptable. Specifically, these students justify their drug use through the use of four recurring prostimulant arguments: 1) comparison-and-contrast, 2) all-things-in-moderation, 3) self-medicating, and 4) minimization arguments. We discuss limitations to the study and conclude by suggesting five strategies for prevention researchers that would directly target these four arguments.

Illicit use of prescription ADHD medications on a college campus: a multimethodological approach.

OBJECTIVE: The authors used quantitative and qualitative methodologies to investigate college students' perceptions and use of illegal Attention Deficit Hyperactivity Disorder (ADHD) stimulants during spring and summer 2006. PARTICIPANTS: From fall 2005 through fall 2006, the authors studied 1,811 undergraduates at a large, public, southeastern research university in the United States. METHODS: The authors administered surveys to these students and conducted 175 in-depth interviews. RESULTS: Of the study participants, 34% reported the illegal use of ADHD stimulants. Most illegal users reported using ADHD stimulants primarily in periods of high academic stress and found them to reduce fatigue while increasing reading comprehension, interest, cognition, and memory. Furthermore, most had little information about the drug and found procurement to be both easy and stigmafree. CONCLUSIONS: This study supplies a rich understanding of the growing national trend of illegal ADHD stimulant use. The authors discuss strategies for stemming the tide of ADHD stimulant use.

Smoke screen: an ethnographic study of a cigar shop's collective rationalization.

It is the purpose of this ethnographic study to explain why efforts from the medical establishment, the press, and friends and family are unsuccessful in persuading a group of men at a local cigar shop to stop smoking. I also seek to determine how these men create a linguistic defense shield that, ironically, protects them from the anxiety that such messages are designed to produce. I argue that the regulars at the shop collectively craft and share 6 prosmoking arguments that (a) rebuke the findings of the medical establishment, (b) anesthetize the regulars from the impact of antismoking messages, and (c) relieve cognitive dissonance and anxiety created by the act of smoking. I establish a theoretical foundation for the study, describe how the regulars craft and converge their collective narratives, and detail the 6 collectively created prosmoking narratives most frequently used by the regulars in countering antismoking messages.

Sometimes a cigar [magazine] is more than just a cigar [magazine]: pro-smoking arguments in Cigar Aficionado, 1992-2000.

Since its first issue in 1992, few periodicals have enjoyed the rapid growth and international popularity of Cigar Aficionado. Although the magazine professes to simply celebrate "the good life and the joys of cigar smoking," we argue that it serves a more insidious function; specifically, the periodical supplies readers with 7 persuasive strategies aimed at rebuking dominant anti-smoking health assertions: (a) the cigars-are-not-cigarettes argument, (b) the life-is-dangerous argument, (c) the health-benefits argument, (d) the moderation argument, (e) the old-smokers argument, (f) the bad-science argument, and (g) the good-science argument. These pro-smoking arguments ultimately serve to relieve the cognitive dissonance associated with the consumption of a potentially deadly product and to maintain a loyal readership, free from guilt or anxiety.