Three Essays on Family, Health, and Opioid Misuse Trajectories in the Transition to Adulthood
Restricted (Penn State Only)
- Author:
- Chapman, Alexander
- Graduate Program:
- Sociology
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 13, 2023
- Committee Members:
- Ashton Verdery, Chair & Dissertation Advisor
John Iceland, Major Field Member
Shannon Monnat, Special Member
Hobart Cleveland, Outside Unit & Field Member
Eric Baumer, Major Field Member
Michelle Frisco, Program Head/Chair - Keywords:
- Substance use
Opioid
Health and Wellbeing
Family Formation
Cohort Analysis - Abstract:
- Drug misuse is among the chief social problems the United States is facing and has faced in the past half century. Increasingly, researchers focus on drug-related mortality, and with good reason, as it contributes to consecutive years of life expectancy declines. Opioids have contributed to about two-thirds of drug overdose deaths since the end of the 20th century, nearing 700,000 opioid deaths through 2021. However, opioid overdoses most often occur among those who are in their late twenties to late forties, and sociologists have given relatively less attention to opioid misuse patterns among adolescent and young adult ages where most people begin their opioid misuse careers. The current uptick in drug-related mortality began in the 1970s, and since that period there have been major changes in drug enforcement policies, the availability and marketing of drugs, economic structure, and demographic shifts in the population from a traditional household model to a dynamic household model. Understanding patterns in opioid misuse in the past 50 years lends itself to the development and expansion of sociological and demographic theory. Moreover, advancing knowledge in this vein may help advance proactive policy maneuvers to reduce the consequences of opioid misuse. To address the current crisis and potential future crises more effectively, it is crucial to adopt perspectives and solutions that prioritize upstream thinking. This involves placing a greater emphasis on understanding the historical context of the present situation and providing explanations for how it came about. Furthermore, it requires a comprehensive examination of the far-reaching consequences of the substance use crisis and the necessary adjustments at the individual- and structural-levels to mitigate risks and enhance protection. This dissertation uses data from the Monitoring the Future study, dating since 1976, where respondents give detailed information on substance misuse, demographic background, and health characteristics. In Chapter 1, I provide a brief overview of the chemical workings of opioids, their history around the world, and their specific history in the United States. This sets the backdrop for the remaining chapters and explains that opioids have been prominent in many societies for a long time but that they have been especially deadly over the past couple of decades. Chapter 1 leads into the primary research question for Chapter 2. In Chapter 2, my first empirical chapter, I consider whether the massive spikes in prescription pain reliever misuse of the mid-late 1990s was due to an age, period, or cohort effect. I find that opioid misuse trends are consistent with a cohort effect. I place this finding in the context of supply versus demand-side drivers of the crisis and highlight that feedback from the recursive relationship between supply and demand likely caused the crisis. In Chapter 3, I test the relationships between opioid misuse and health and wellbeing in young adulthood. I consider differences across age of initiation, differences across time, and differences across cohorts. I find that those who misuse opioids have more symptoms of poor health and that differences are especially pronounced at younger ages. This analysis provides new nationally representative evidence using panel data of the health consequences of opioid misuse over the span. These findings, even without differentiating by the duration of use, further highlight the value of interventions at younger ages. In Chapter 4, I test the social characteristics of opioid misuse. I consider differences by family formation, gender, across age. This analysis offers a new understanding of family processes and highly deviant behaviors while embedding these findings in demographic trends. Prior research on the topic focuses on commonly used substances like alcohol, but I focus on opioids to advance understandings of the causal association between family formation and these less-commonly used substances. My findings show that marital status is protective, while coresident children have more mixed associations. Though marrying or having children at young ages is less protective than older ages. In the last chapter, Chapter 5, I bring the findings together describing the long run age, period, and cohort contributions of the crisis in the United States, the health consequences – even beyond overdose, and what the changing social structure of the United States means for social connections and what that may mean for drug trends. My dissertation offers methodological and theoretical contributions to scholarship on the interplay between social and demographic patterns and health behaviors and wellbeing. My three major contributions are 1) I use arguably the best data available to test whether the surge in PPR-related mortality and misuse was due to age, period, or cohort effects, 2) with repeated panels, I show varying health risks of opioid misuse across ages in young adulthood, across time, and across cohorts, and 3) I extend scholarly understanding of whether family formation patterns are protective of opioid misuse (or downstream consequences) using temporal ordering and individual fixed effects.