title: Associations between adverse childhood experiences, student-teacher relationships, and non-medical use of prescription medications among adolescents.
abstract: Few studies have investigated associations between adverse childhood experiences (ACE) and nonmedical use of prescription medication (NMUPM) in population-based samples of adolescents, and even fewer have examined whether promotive factors might buffer these effects. The present study assesses the direct effects of ACE and positive student-teacher relationships on NUMPD and whether positive student-teacher relationships moderate this association.
  
  
  
  Data were from the 2013 Minnesota Student Survey (MSS), an in-school survey administered every three years to students throughout Minnesota. The analytic sample (n=104,332) was comprised of 8th, 9th, and 11th graders.
  
  
  
  Approximately 3% of students acknowledged past year NMUPM, the majority of whom reported at least one ACE. The most frequently used prescription drug was Ritalin/ADHD medications (1.71%) followed by opiate-based painkillers (1.67%), tranquilizers (0.92%), and stimulants (0.75%). Students who reported any use tended to use more than one medication. For every additional ACE, there was a 56%, 51%, 47%, and 52% increase in the odds of past year stimulant use, ADHD medication, pain reliever, and tranquilizer use, respectively. The estimated rate of the number of prescription drugs used increased by 62% for every additional ACE. Positive student- teacher relationships buffered the association between ACE and NMUPD, especially at higher levels of ACEs.
  
  
  
  Our findings have important implications for prevention work. Training educators to recognize trauma symptomology and cultivating strong student-teacher relationships are important considerations for future school-based substance use prevention initiatives.
authors.affiliation: Division of General Pediatrics and Adolescent Health - Department of Pediatrics, University of Minnesota, MN, United States. Electronic address: mforster@umn.edu.
authors.forename: Myriam
authors.initials: M
authors.lastname: Forster
authors.affiliation: Division of General Pediatrics and Adolescent Health - Department of Pediatrics, University of Minnesota, MN, United States.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Gower
authors.affiliation: Division of General Pediatrics and Adolescent Health - Department of Pediatrics, University of Minnesota, MN, United States.
authors.forename: Iris W
authors.initials: IW
authors.lastname: Borowsky
authors.affiliation: Division of General Pediatrics and Adolescent Health - Department of Pediatrics, University of Minnesota, MN, United States.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: McMorris
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D063487:Prescription Drug Misuse / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D000070777:School Teachers / Q000523:psychology* / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data