Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)

Graduate Group


First Advisor

Jennifer Pinto-Martin





Sydney A. Axson, MPH, RN

Jennifer A. Pinto-Martin, PhD, MPH

Since peaking in the 2000s, increased attention has focused on the use of prescription

opioids. While much is known about the use of these medications in adults, much less is

understood about their use in the adolescent population. This dissertation first synthesized

the literature to identify and discuss factors associated with the non-medical use of

prescription drugs. These factors are important to consider in weighing the benefits and

risks of prescription medications, including opioids, for adolescent patients. Next, a

cross-sectional analysis of adolescents discharged from one hospital system with a pain

medication between January 2015 and January 2017 was conducted to identify factors

associated with receiving and opioid prescription after an acute care visit of 48 hours or

less. This analysis identified older age, higher pain scores, and having surgery to be

associated with increased odds of being discharged with an opioid prescription. Patients

on Medicaid or who self-pay, as well as those discharged from an emergency department

or urgent care center were significantly less likely to receive an opioid prescription.

Prescriber licensure, race, and gender were not significantly associated with opioid

prescribing. Next, using the electronic health record, a cross-sectional analysis of a

random sample of over 9,000 patients discharged from one hospital system after a stay of

5 days or less from January 2015 to December 2019 was conducted to understand

prescribing over time. Four outcome groups were created to conduct a multivariable

multinomial logistic regression 1) discharged with no medication, 2) discharged with a

non-opioid only, 3) discharged with an opioid only, 4) discharged with both an opioid

and a non-opioid. Controlling for patient and clinical characteristics that may contribute

to the need for an opioid medication, we found that the odds of receiving an opioid only

at time of discharged decreased over time, while receiving a non-opioid only at time of

discharge increased over time. Collectively, this dissertation contributes to an

understanding of prescribing opioids to adolescent patients. Findings from this work will

be helpful for developing future nurse-led educational interventions aimed to promote

safe prescribing and safe medication use in the adolescent population.