Date of Conferral

9-7-2026

Date of Award

September 2026

Degree

Doctor of Public Health (DrPH)

School

Health Sciences

Advisor

Twanda Wadlington

Abstract

This study examined adolescent opioid misuse in the United States and the role of school-based prevention. Guided by the health belief model, the purpose was to test whether participation in school-based drug prevention lessons was associated with past-year opioid misuse among adolescents ages 14–17 and whether race and gender moderated that association. This quantitative, cross-sectional, nonexperimental secondary analysis used the 2019 National Survey on Drug Use and Health (N = 8,965). Analyses included weighted descriptives, chi-square tests, and complex-samples logistic regression controlling for age and socioeconomic status. The sample included adolescents ages 14–17 with complete data on school-based prevention participation, past-year opioid misuse, race, gender, age, and socioeconomic status. School-based prevention participation was associated with lower odds of past-year opioid misuse, Wald F(1, 50) = 9.27, p = .004, OR = 0.549, 95% CI [0.369, 0.815]. Race did not significantly moderate the association, Wald F(2, 49) = 0.09, p = .913. Gender significantly moderated the association, Wald F(1, 50) = 4.66, p = .036, with a stronger protective association for female adolescents and a weaker association for male adolescents. Age remained significant as a predictor of opioid misuse, Wald F(1, 50) = 11.03, p = .002, OR = 1.294, 95% CI [1.107, 1.512], indicating higher odds of misuse with each additional year of age. The findings were translated into field-based products and recommendations focused on early, skills-based, gender-responsive, and culturally respectful school prevention. Positive social change may include supporting safer and more equitable learning environments.

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