Youth Opioid Prevention: A Community Health Promotion Plan

Introduction

Opioid abuse is a serious problem in the United States, particularly among the youth population. This health risk behavior has persisted for quite some time, largely due to the pharmaceutical industry's aggressive promotion of drugs like OxyContin (Coplan et al., 2016). The US Department of Health and Human Services (2020) reports that 0.7 percent of young people aged 12 and older have reported an opioid use disorder—such as heroin or prescription pain reliever misuse—in the past 12 months. One of the objectives of Healthy People 2030 is to "reduce the proportion of people who had opioid use disorder in the past year" (Healthy People 2030, 2021). This paper discusses a program that can be initiated to address this issue. It identifies the target group, the key stakeholders, the plan of action, and the barriers to be overcome.

Health promotion is needed to prevent further abuse and to reduce current numbers. For instance, in Pennsylvania, Governor Wolf "voiced his support for House Bill 1190, which proposes a school-based substance abuse prevention and intervention program for all students in grades kindergarten through 12" (Governor.PA, 2017). Minority youths are particularly at risk because of the prevalence of opioids in urban areas such as Pittsburgh and Harrisburg. Educating adolescents about the dangers of these drugs is one intervention that can be conducted. Another is to use social media to increase health literacy about opioid use and to promote an abstinence program in which teens pledge not to use opioids—a space where people can share stories and provide mutual support. Because social media is the most popular media space among teens today, it is a natural platform for an intervention aimed at increasing health literacy (Doster, 2013; Roberts, Callahan & O'Leary, 2017).

The target group is urban youth ages 12 and older who are susceptible to opioid use because of their environment. This is a vulnerable population at risk for developing an opioid use disorder, given the availability of these drugs on the streets and the culture of drug use that has become increasingly prevalent among young people. As Healthy People 2030 notes, the baseline for this population is 0.7 percent; the goal of this program is to reduce that figure to 0.5 percent.

Target Group and Health Determinants

The determinants of health relevant to this target group are environmental, economic, and cultural factors. Environmentally, many teens who live in urban areas are surrounded by opportunities to engage in drug use. They are also heavy consumers of media in which drug use is heavily promoted—particularly in music, hip-hop videos, films, and streaming content. A counter-culture of abstinence from opioids must therefore be actively promoted to compete with these messages.

Economically speaking, many of these youths come from impoverished families or communities near the poverty line. However, that is not universally the case; many users also come from suburban or even affluent households. Opioid misuse is therefore not an issue divided neatly along class lines—it spans all socioeconomic levels.

Culturally, the main drivers are peers, groups, and media (Bandura, 2018). The culture of drug use is heavily promoted in media that targets adolescents and older teens, and these teens face further peer pressure to engage in opioid use (McCoy, Dimler, Samuels & Natsuaki, 2019; Xu & Cao, 2020). Groups such as churches and schools can be positive sources of cultural influence, but they are not always actively engaged in promoting health literacy with respect to opioid use and drug avoidance.

To promote resistance to opioid use among the youth population, Keleher's Framework for Health Promotion Action should be utilized. This framework begins by identifying the causes that affect the health issue and then establishes what priorities need to be put in place to generate upward investment. This process draws various stakeholders—from educators and nurse practitioners to social media influencers and celebrities—into action to combat the health problem (Keleher, 2002). With these stakeholders engaged, a broad movement can get underway to facilitate the objectives of the Healthy People 2030 campaign and promote accountability among the target population by reinforcing positive narratives that encourage resistance to opioid use.

This model is well suited to the intervention strategy of using social media as a foundation for reaching the target population. Social media is where young people interact more than anywhere else. Because it is a new, participatory medium rather than traditional broadcast media, individual users can have significant influence over how content is shaped and shared.

Health Promotion Theory

The model first issues a directive to responsible adults to do their part. This means enlisting parents and teachers to play an active role in educating the young population about the dangers of opioids. Young people are already receiving one message from mainstream media—that drugs are glamorous or harmless—so they need to be shown that the reality of drug use is very different. Opioids can lead to addiction and death; they ruin lives. Young people rarely receive that message from popular media. One important principle of this model is that it associates civic responsibility with the intervention: everyone has a role to play.

The model also requires the identification of danger factors. In the case of opioid use among young people, those factors are peers, media, and opportunity. Youths who are not engaged in something positive, constructive, and meaningful are more prone to drug use. It is therefore important that youths have access to clubs or after-school organizations where they can develop skills and work toward new opportunities. Business owners can take on young people as apprentices in a trade; educators and community leaders can sponsor programs offering games, sports, or tutoring. The key is to keep young people busy with positive diversions that support their moral, intellectual, physical, and social development. By keeping them constructively engaged, youths can be steered away from dangerous media or peer environments and toward healthier perspectives on life.

This leads to investment that creates more opportunities for young people. Drugs become appealing to many because they feel trapped with nowhere to go, and drug use becomes a cheap mental escape—one that ultimately causes serious harm. As stakeholders and programs come together, advocates for change can converge on social media, using platforms like Twitter and Facebook to promote the initiative and build momentum.

The rationale for this model is that it is integrative and holistic, bringing together the various aspects of community support needed for the positive development of youth. Education about the dangers of opioid use is necessary but not sufficient. Youth also need programs that occupy their time constructively. They need support on social media where they can share stories and receive reinforcement from positive voices who, while perhaps not physically present in their communities, can be part of their lives virtually. Social media advocates and influencers can become stakeholders who help teens avoid opioids. Harmful media narratives should be challenged and replaced with positive, health-affirming content.

The primary goal is to reduce youth opioid usage by 0.2 percent in accordance with Healthy People 2030 objectives. There are also secondary goals that will support this objective and potentially make the program even more successful: to develop and implement programs that provide meaningful developmental opportunities for urban youth.

Key stakeholders will operate within the three spheres of influence identified by Bandura (2018): peers, groups, and media. Among peers, stakeholders include members of the target population themselves—the young people who will receive education in schools about the dangers of opioid use, participate in after-school and apprenticeship programs, engage with church-based initiatives, and be reached through the social media campaign. Their responses, stories, and development must be monitored and evaluated to assess the program's true impact.

Other stakeholders include educators who will work alongside healthcare workers to provide accurate and meaningful information to increase health literacy; community leaders, business owners, tradespeople, and church leaders who can offer direct programming; and coaches, parents, and social media influencers who can shape positive narratives through groups and media.

What. The plan focuses on the three spheres of influence, beginning with schools. The Governor of Pennsylvania has already expressed support for opioid education among youth—that is the starting point. The next step is to recruit churches, businesses, and sports clubs to join the campaign. Simultaneously, a social media campaign should be launched to promote resistance to opioids. While stakeholders engage young people in extracurricular activities such as sports, tutoring, and trade learning, the social media campaign amplifies the same message—encouraging youths to share stories about opioid misuse and see the value of meaningful engagement over drug use. The goal is broad involvement across multiple channels, with social media keeping the positive momentum going.