Lipson, Sarah KetchenFreibott, Christina Elliott2025-05-132025https://hdl.handle.net/2144/504042025The rate of unintentional drug overdose deaths among adolescents and young adults (AYAs) increased 147% between 2015 and 2022 despite otherwise stable rates of substance use. Overdoses involving fentanyl (a highly potent synthetic opioid) tripled among AYAs from 2019 to 2021. Evidence indicates that fentanyl is being added to nonopioid drugs, including stimulants (e.g., Adderall, Ritalin, cocaine) and counterfeit pills, implicating a much broader range of AYAs beyond those who knowingly use opioids. For numerous reasons—including that more than half of all AYAs enroll in US postsecondary education—colleges and universities represent an important setting to understand and prevent opioid misuse and overdose nationwide. Utilizing three levels of data—population-level student survey data, college-level policy data, institutional leaderin-depth interview data—the immediate objective of this dissertation is to understand the current state of student opioid knowledge and opioid overdose prevention in higher education. The long-term goal of this research is to generate evidence to inform the design and implementation of opioid overdose and harm reduction programs and policies for the more than 20 million college students in the US. The three chapters of this dissertation aim to: (1) comprehensively describe current public health approaches to prevent opioid-related harms in college and university settings; (2) estimate, using national survey data from the Healthy Minds Study (HMS), college students’ willingness to intervene during an overdose through their (i) opioid-related knowledge, (ii) social relationships, and (iii) campus connectedness; and (3) explore, using in-depth interviews, perceptions of and decision-making by higher education leaders regarding student opioid misuse and overdose prevention programming in college settings. This dissertation research is innovative as it is the first known study to use large-scale, multi-campus data from college students to examine their knowledge of opioid overdose risk, naloxone, and willingness to intervene during an overdose. It is significant as the findings will have a broader impact on filling gaps relating to opioid overdose prevention in higher education settings.en-USPublic healthSubstance misuseSubstance useUniversityThesis/Dissertation2025-05-090000-0002-9033-8317