Young Adult African Immigrants in the United States: Examining Pathways from Childhood Adversity to Prescription Drug Misuse

Background and Purpose:

In recent years, deaths due to non-medical prescription drug use (NMPDU) have doubled and SAMHSA reports that a combined total of about 23.3 million people reported misusing psychotherapeutic or pain reliever medication. Evidence suggests that the young adult population has the highest rates of both misuse and death due to NMPDU. Associated with NMPDU is the occurrence of adverse childhood experiences (ACEs). In the United States, 1 in 6 adults have 4 or more types of ACEs before the age of 18 with racial and ethnic minority populations experiencing a disproportionate burden of childhood adversity and health risk. This study examines the effects of ACEs on non-medical prescription drug use among young adult African immigrants, an understudied population despite increased vulnerability for marginalization and negative outcomes. We also explore whether internalizing mental health symptoms, discrimination, and self-esteem mediate this relationship.

Methods:

This study utilized cross-sectional data from 1st and 2nd generation African immigrants in the United States (N=297). Participants were between the ages of 18 to 25, primarily female (74%) and Black (87%). The 10-question adverse childhood experience questionnaire was used to measure ACEs (ɑ = .91). NMPDU was measured using a continuous measure assessing the frequency of prescription drug use without doctor permission in the past 12 months. Mediators were assessed using the Rosenberg Self-Esteem scale (ɑ = .73), the 25-item Hopkins Symptom Checklist (ɑ = .96), and the 5-item Everyday Discrimination Scale (ɑ = .79). We also controlled for gender, education, income, and immigrant generation. SPSS with PROCESS macro was used to examine study hypotheses.

Results:

In this sample, 46% of people reported having experienced 4 or more ACEs and 55% of the sample reported misuse of prescription drugs in the last 12 months. OLS regression showed that the direct effects of ACEs on NMPDU remained significant even when controls were added to the model (β = 0.39; p < 0.001). Mediation results showed that ACEs were related to NMPDU via self-esteem (β = -0.19, p <.001), internalizing symptoms (β = 0.21, p < .001) and discrimination (β = .16. p < .01).

Conclusion and Implications:

Findings suggest that mental health, self-esteem, and discrimination function as mechanisms through which ACEs influence NMPDU. Thus, efforts to decrease NMPDU should consider bettering mental health supports, avenues to increase self-esteem, as well as to mitigate discrimination for immigrants with a history of childhood adversity. Future research can explore protective factors for NMPDU among African immigrants and if variation exists by immigrant generation.