| Background: According to recent estimates, approximately one third of college students have engaged in nonmedical use of prescription stimulants (NPS) which is both dangerous and illegal, yet most universities do not have programs in place to address this growing public health concern.;Methods: This mixed-methods study used in-depth interviews (n=8), four focus groups (n=17), and cognitive interviews (n=5) to elicit, refine, and vet attributes for the development of two preference elicitation instruments (Phase 1) that were used in an online survey (Phase 2). The preference elicitation instruments included a best-worst scaling (BWS) instrument that assessed college students' priorities around perceived benefits and risks of NPS and a discrete-choice experiment (DCE) that measured students' preferences for components of a college-sponsored NPS reduction program.;Results: Thirty and 259 college students participated in Phase 1 and Phase 2, respectively. All participants were 18-25 years old, enrolled at a public university in Maryland, and a self-reported past-year NPS user. The majority were upperclassman (71%), female (57%), and white (66%). Phase 1 yielded 12 attributes related to students' perceived academic, punitive, health, and social benefits and risks of NPS and four three-level attributes related to components of an NPS reduction program: setting, leader, discussion topics, and additional resources. In Phase 2, for the BWS, participants prioritized the benefits and risks of NPS. Better grades and meeting deadlines, followed by college expulsion and limited future career opportunities, were most important concerns when engaging in NPS. A latent class analysis (LCA) yielded four segments with different priorities for NPS. For the DCE, program setting and leader most influenced participants' preferences for a college-sponsored NPS reduction program. A LCA generated three segments with heterogeneous preferences for components of a program.;Conclusions: This dissertation is the first to apply advanced preference elicitation methods to the field of substance use. We identified college students' modifiable expectancies that most influence on NPS and their preferences for the delivery of an NPS reduction program in which they would be willing to engage. These findings can inform the delivery of personalized NPS reduction programs to maximize engagement. |
