ABSTRACT PRESCRIPTION OPIOIDS AND ADOLESCENTS: FACTORS ASSOCIATED WITH NONMEDICAL USE AND PRESCRIBING PRACTICES 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.