03/25/2022
By Maureen Martin

The Zuckerberg College of Health Sciences, Solomont School of Nursing, invites you to attend a doctoral dissertation defense by Inyene Essien on "Sociocultural Factors Associated with Persistent Prescription Opioid Use Among Puerto Rican Adults in Massachusetts."

Date: Friday, April 8, 2022
Time: 9:30 a.m. to noon
This will be a virtual defense via Zoom. Those interested in attending should email Inyene_Eissien@student.uml.edu and committee chair Yuan_Zhang@uml.edu at least 24 hours prior to the defense to request access to the meeting.

Committee Chair: Yuan Zhang, Ph.D., RN, Associate Professor, Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell

Committee Members:

  • Ainat Koren, Ph.D., DNP, PMHNP, Ph.D. Director and Associate Professor, Solomont School of Nursing, University of Massachusetts Lowell
  • Natalia Palacios, Sc.D., Assistant Professor, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell

Abstract:

Background: Understanding ecological-level factors associated with persistent prescription opioid use (PPOU) may inform research and efforts to reduce prescription opioid-related complications. Puerto Rican Adults (PRAs) have disparities in health outcomes and depression and may be at greater risk of PPOU. Determinants of allostatic loads, including acculturation, migration history, social support, perceived discrimination, have not been explored as correlates of PPOU among PRAs. Further, no study has explored whether depressive symptoms affect PRA’s PPOU. Opioid overdose fatality rates among Hispanics have further increased amidst the ongoing Covid-19 pandemic, amplifying the need for exploration of socio-ecological level factors associated with PPOU.

Aim: The primary aim of this study was to estimate the incidence and prevalence of prescription opioid use (POU) among PRAs and to evaluate whether sociocultural factors of acculturation and migration history (intrapersonal), social support and network size (interpersonal), and perceived discrimination (community level) predicted PPOU. Furthermore, this study examined the relationship between depression and PPOU and whether depression mediated the effects of perceived discrimination on PPOU.

Method: The Socio-Ecological Model (SEM) was adapted to guide this longitudinal secondary analysis study of the Boston Puerto Rican Health Study (BPRHS) cohort. The BPRHS is an ongoing cohort study of PRAs in the Greater Boston area. Baseline (0-year), 2-year, and 5-year datasets were used to estimate incidence and prevalence of POU among the PRA’s cohort. The measures were acculturation and migration history, social support and network size, perceived discrimination, depression symptoms, and PPOU. Association between incidence and prevalence of POU by demographic factors were examined. The relationship between SEM-level factors and depression were examined with binary logistic regression. Using Baron and Kenny's method (1986), multivariable binary logistic and linear regression models examined whether depression mediated the effects of perceived discrimination on PPOU.

Results: Participants were 45-75 years old (N=798) of Puerto Rican descent (72.9% women) with 6.5% persistent opioid users compared to non-users (93.5%). Increasing incidence and prevalence of POU were observed at each follow-up. Lower income households were more likely to have higher incidence and prevalence of POU. Multivariate logistic regression models revealed an association between perceived discrimination and PPOU (OR=2.85, 95% CI 1.46-5.58). No association was observed between acculturation, migratory history, social support and PPOU. Depressive symptoms were associated with PPOU (OR=1.03, 95% CI: 1.00-1.05, p <0.03) and partially mediated the effects of perceived discrimination on PPOU by 10.3%, after adjustment of covariates.

Conclusion: Reports of associations between perceived discrimination, depression and PPOU broadens current knowledge on factors linked to PPOU in the PRAs subpopulation. This research has important implications for policy, nursing research and clinical practice. Nurses and healthcare professionals may design tailored interventions to reduce PPOU by targeting these risk factors. Addressing perceived discrimination and depressive symptoms may impact PRA’s exposure to PPOU and reduce their risk of prescription opioid-related complications. Future research should explore other multi-level factors that may influence PPOU and other potential mechanisms that may explain the effects of perceived discrimination on PPOU.

Keywords: acculturation, depressive symptoms, migration history, persistent prescription opioid use, perceived discrimination, Puerto Rican adults, Socio-Ecological Model, social support, and network size