Schnellinger, Rusty P. (2020). Disorganization, Communities, and Prescription Drugs: An Investigation of the Social Context of Non-Medical Use.
Prevalence of nonmedical use of prescription drugs (NMUPD) has risen dramatically during the past two decades. Studies meeting the demand for empirical research on this phenomenon have mainly identified individual-level drivers of NMUPD. While such identification assists in understanding these trends, few studies have considered the social drivers of NMUPD. This is surprising given 1) prevalence varies according to neighborhood type (i.e., rural, urban, suburban) and 2) the wealth of empirical and theoretical literature connecting social factors to health behaviors, deviant behavior, and use of other illicit substances. The goal of this dissertation is to situate the NMUPD as a social problem by investigating its structural sources and social determinants. I use social disorganization theory (Sampson and Groves 1989; Shaw and McKay 1942) and associated “neighborhood effects” frameworks (Brooks-Gunn et al. 1993; Gephart 1997; Leventhal and Brooks-Gunn 2000), to frame the NMUPD epidemic as a product of social-structural (i.e., macro) forces that are mitigated by community-level mechanisms. Using two waves of data from the National Longitudinal Study of Adolescent Health (Add Health), I generate logistic regression models testing the effects of macro-level predictors on individual odds of NMUPD, as well as the intervening roles of collective efficacy (Fagan, Wright, and Pinchevsky 2014; Sampson, Raudenbush, and Earls 1997; Theall et al. 2009), depressive symptoms (Aneshensel and Sucoff 1996; Ross 2000), and access to healthcare (Browning and Cagney 2002; Ross and Mirowsky 2001) in this relationship. Findings highlight the neighborhood context as a source of variation in NMUPD. Results indicate that living in a disorganized neighborhood is associated with increased odds of engaging in NMUPD and highlight neighborhood residential instability as an important risk factor. Further analyses reveal that this association is stratified, with female residents bearing the most substantial risk for NMUPD associated with living in a disorganized neighborhood. The dissertation address the structural basis of individual NMUPD with implications for extending theory and informing public policy.
Schnellinger, Rusty P.
Doctor of Philosophy
Kent State University