Association Between Prescription Opioid Misuse and Risky Health Behaviors Among High School Students in the U.S.: A Cross-Sectional Study 2017–2021

Objective: The objective of this study was to investigate the association between prescription opioid misuse and 18 risky health behaviors among high school students in the United States.Material and Methods: This study utilized the most recent 2017, 2019, and 2021 Youth Risk Behavior Surveillance System (YRBSS) nationally representative data of n=44,329 high school students (Grades 9-12). We created 2 groups based on participants who reported lifetime prescription opioid misuse and those who did not. Bivariate analysis included Pearson’s chi-squared tests to compare the baseline differences between the 2 groups. For multivariate analysis, a survey-weighted logistic regression model, which adjusted for socio-demographic factors, was used to explore the association between prescription opioid misuse and selected risky health behaviors.Results: The adjusted multivariate model showed a significant association between prescription opioid misuse and risky health behaviors related to driving, suicidal ideation, and illicit substance use. Significant associations were found between prescription opioid misuse and suicidal ideation, which included feelings of hopelessness and seriously considering suicide. However, no significant relationship was observed between making plans for suicide and attempting suicide.Conclusion: The findings highlight that high school students with a history of prescription opioid misuse engaged in other adverse health behaviors. Public health policymakers should consider these findings in order to take a multifaceted approach by working with teachers, counselors, and clinicians to create programs to assist the high school students who are part of this high-risk population.