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Li Y, Rhubart D. Cannabis use, social support and social engagement among working-age adults in rural America. Prev Med Rep 2024; 43:102794. [PMID: 38975281 PMCID: PMC11225026 DOI: 10.1016/j.pmedr.2024.102794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/04/2024] [Accepted: 06/07/2024] [Indexed: 07/09/2024] Open
Abstract
Objective Cannabis use has been linked to physical, psychological, and behavioral changes. Although research indicates separately that informal social support and formal social engagement - which are correlated measures - serve as protective factors in cannabis use, much of this research focuses on youth and more urban samples, limiting our understanding of if these findings are true for rural populations where social support and social engagement are particularly important for health and health behaviors. To fill the research gap, this study examines the effects of informal social support (tangible support and emotional support) and formal social engagement on cannabis use among rural working-age adults. Methods This research analyzed 1,122 observations from a cross-sectional online survey conducted in 2022 of working-age adults (18-64) from rural America. Multilevel logistic regression models were used to predict cannabis use in the past 12 months using informal social support (tangible support and emotional support) and formal social engagement and other sociodemographic covariates and state legalization status. Results Multilevel logistic modeling indicates that low emotional support and low formal social engagement are associated with a higher odds of reporting cannabis use in the past 12 months among rural working-age adults, net of other sociodemographic variables and state legalization status. Conclusions The study suggests that emotional support and social engagement may contribute to cannabis use prevention among rural working-age adults. These findings should inform future research as well as the development of tailored health interventions targeting rural working-age adults.
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Affiliation(s)
- Yiping Li
- Department of Biobehavioral Health, The Pennsylvania State University, Biobehavioral Health Building, University Park, PA 16802, USA
| | - Danielle Rhubart
- Department of Biobehavioral Health, The Pennsylvania State University, Biobehavioral Health Building, University Park, PA 16802, USA
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Dyar C, Morgan E. Rural and urban differences in disparities in substance use and substance use disorders affecting sexual minority populations. J Rural Health 2024; 40:542-556. [PMID: 38112341 PMCID: PMC11187699 DOI: 10.1111/jrh.12816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Sexual minority populations are at elevated risk for substance use (SU) and substance use disorders (SUD) compared to heterosexual populations. These disparities are theorized to be amplified for rural sexual minority populations due to their increased exposure to minority stress and reduced access to sexual minority communities. However, there is a lack of research examining differences in SU disparities affecting sexual minority populations by urbanicity, and little research has examined differences in SUD treatment utilization by sexual minority status or urbanicity. METHODS We utilized data from 2015 to 2019 National Survey on Drug Use and Health to examine disparities in SU, SUD, SUD treatment utilization, and unmet SUD treatment need between sexual minority and heterosexual populations and test whether such disparities vary by urbanicity. RESULTS Results indicate that disparities in SU and SUD affecting sexual minority populations generalize across urbanicities. A subset of disparities differed by urbanicity, and the direction of these differences varied, with some disparities being stronger in urban than rural populations and vice versa. Despite elevated treatment utilization among some sexual minority groups, disparities in unmet SUD treatment need were prevalent across urbanicities and sexual identity groups. CONCLUSIONS Study findings highlight the ubiquity of disparities in SU, SUD, and unmet SUD treatment need affecting rural and urban sexual minority populations, while also demonstrating nuanced differences in disparities by urbanicity. The persistence of disparities in unmet SUD treatment need emphasizes the need for future research to identify factors contributing to this disparity and for policies that alleviate these disparities.
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Affiliation(s)
- Christina Dyar
- College of Nursing, Ohio State University, Columbus, Ohio, United States of America
| | - Ethan Morgan
- College of Nursing, Ohio State University, Columbus, Ohio, United States of America
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Peddireddy SR, Livingston MD, Young AM, Freeman PR, Ibragimov U, Komro KA, Lofwall MR, Oser CB, Staton M, Cooper HLF. Willingness to utilize a mobile treatment unit in five counties at the epicenter of the US rural opioid epidemic. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209262. [PMID: 38103835 PMCID: PMC10947911 DOI: 10.1016/j.josat.2023.209262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/26/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION US federal policies are evolving to expand the provision of mobile treatment units (MTUs) offering medications for opioid use disorder (MOUD). Mobile MOUD services are critical for rural areas with poor geographic access to fixed-site treatment providers. This study explored willingness to utilize an MTU among a sample of people who use opioids in rural Eastern Kentucky counties at the epicenter of the US opioid epidemic. METHODS The study analyzed Cross-sectional survey data from the Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE) study covering five rural counties in the state. Logistic regression models investigated the association between willingness to utilize an MTU providing buprenorphine and naltrexone and potential correlates of willingness, identified using the Behavioral Model for Vulnerable Populations. RESULTS The analytic sample comprised 174 people who used opioids within the past six months. Willingness to utilize an MTU was high; 76.5 % of participants endorsed being willing. Those who had recently received MOUD treatment, compared to those who had not received any form of treatment or recovery support services, had six-fold higher odds of willingness to use an MTU. However, odds of being willing to utilize an MTU were 73 % lower among those who were under community supervision (e.g., parole, probation) and 81 % lower among participants who experienced an overdose within the past six months. CONCLUSIONS There was high acceptability of MTUs offering buprenorphine and naltrexone within this sample, highlighting the potential for MTUs to alleviate opioid-related harms in underserved rural areas. However, the finding that people who were recently under community supervision or had overdosed were significantly less willing to seek mobile MOUD treatment suggest barriers (e.g., stigma) to mobile MOUD at individual and systemic levels, which may prevent improving opioid-related outcomes in these rural communities given their high rates of criminal-legal involvement and overdose.
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Affiliation(s)
- Snigdha R Peddireddy
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA.
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - April M Young
- Department of Epidemiology and Environmental Health, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice & Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Umedjon Ibragimov
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - Kelli A Komro
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - Michelle R Lofwall
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Carrie B Oser
- Department of Sociology, University of Kentucky College of Arts & Sciences, Lexington, KY, USA
| | - Michele Staton
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
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Viglione J, Childs KK, Peck JH, Chapman JE, Drazdowski TK, McCart MR, Sheidow AJ. Examining the measurement precision of behavior problems among a sample of primarily rural youth on juvenile probation and their parents. CHILDREN AND YOUTH SERVICES REVIEW 2023; 152:107039. [PMID: 38312220 PMCID: PMC10836716 DOI: 10.1016/j.childyouth.2023.107039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Accurate and timely intervention in the justice system is particularly critical in rural communities, given documented barriers to accessible, evidence-based services for youth. As youth in the juvenile justice system have a high prevalence of behavioral health needs, accurate assessment of those needs is a critical first step in linking youth to appropriate care. The goal of the current study is to examine the reliability of a brief assessment (the Brief Problem Checklist [BPC]) among a sample of 222 justice-involved youth and their caregivers who primarily reside in rural communities in the United States. Using a series of reliability analyses and tests of agreement, we examined whether youth and caregiver BPC produces reliable scales, the strength of the convergence among each of the BPC scales, and youth and caregiver agreement on the BPC scales. Findings support the reliability of the BPC, but not inter-rater reliability. Poor agreement between youth and caregiver reports exists for both youth internalizing and externalizing problems. Additionally, the BPC was significantly related to several theoretically relevant constructs, including treatment, substance use disorder severity, and family history of substance use. These findings lend merit to discussions about the need for more research on the reliability and validity of assessment instruments before their widespread use in guiding youth- and agency case planning decisions, along with informing conclusions about program effectiveness.
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Affiliation(s)
- Jill Viglione
- Department of Criminal Justice, University of Central Florida, 12805 Pegasus Drive, Orlando, FL 8216, United States
| | - Kristina K. Childs
- Department of Criminal Justice, University of Central Florida, 12805 Pegasus Drive, Orlando, FL 8216, United States
| | - Jennifer H. Peck
- Department of Criminal Justice, University of Central Florida, 12805 Pegasus Drive, Orlando, FL 8216, United States
| | - Jason E. Chapman
- Oregon Social Learning Center (OSLC), 10 Shelton McMurphey Blvd., Eugene, OR 97401, United States
| | - Tess K. Drazdowski
- Oregon Social Learning Center (OSLC), 10 Shelton McMurphey Blvd., Eugene, OR 97401, United States
| | - Michael R. McCart
- Oregon Social Learning Center (OSLC), 10 Shelton McMurphey Blvd., Eugene, OR 97401, United States
| | - Ashli J. Sheidow
- Oregon Social Learning Center (OSLC), 10 Shelton McMurphey Blvd., Eugene, OR 97401, United States
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Choi S, Bunting A, Nadel T, Neighbors CJ, Oser CB. Organizational access points and substance use disorder treatment utilization among Black women: a longitudinal cohort study. HEALTH & JUSTICE 2023; 11:31. [PMID: 37603194 PMCID: PMC10440874 DOI: 10.1186/s40352-023-00236-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/14/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Health and social service organizations, including the emergency department (ED) and public assistance programs, constitute a social safety net that may serve as an "access point" for substance use treatment utilization. Racialization of substance use disorder (SUD) and gender disparities in access to treatment contribute to differences in health and social service utilization, including substance use treatment for Black women. We therefore explored the role of various access points in facilitating the use of substance use treatment among Black women with substance use and involvement in the criminal justice system. METHODS We used data from the Black Women in the Study of Epidemics (B-WISE) project (2008-2011), which recruited Black women who use drugs from community, probation, and prison recruitment settings in Kentucky. B-WISE is a three-wave panel survey collected on a six-month interval. We estimated dynamic panel models to understand whether time-varying use of services influenced women's substance use treatment utilization over 18-months, adjusting for time-invariant characteristics. We stratified the analysis based on where women were recruited (i.e., community, prison, and probation). RESULTS The sample included 310 persons and 930 person-waves. For the community and prison samples, the use of an ED in the 6 months prior decreased women's likelihood of subsequent substance use treatment use (Coef: -0.21 (95% CI: -0.40, -0.01); -0.33 (95% CI: -0.60, -0.06), respectively). For the probation sample, receiving support from public assistance (i.e., food stamps, housing, cash assistance) increased the likelihood of subsequent substance use treatment use (0.27 (95% CI: 0.08, 0.46)). CONCLUSION Interactions with health and social service organizations predicted Black women's use of substance use treatment services and varied based on their involvement in the criminal justice system. Public assistance venues for Black women on probation may be a point of intervention to increase their access to and use of substance use treatment.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Amanda Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Talia Nadel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Charles J Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
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Oser CB, Batty E, Booty M, Eddens K, Knudsen HK, Perry B, Rockett M, Staton M. Social ecological factors and medication treatment for opioid use disorder among justice-involved rural and urban persons: the Geographic variation in Addiction Treatment Experiences (GATE) longitudinal cohort study protocol. BMJ Open 2023; 13:e066068. [PMID: 36940952 PMCID: PMC10030549 DOI: 10.1136/bmjopen-2022-066068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/23/2023] [Indexed: 03/22/2023] Open
Abstract
INTRODUCTION Three medications are Food and Drug Administration approved for the treatment of opioid use disorder (OUD); however, these medications are underused within prisons, which elevates the risk of relapse and overdose when persons with opioid use disorder (POUD) are released. Research is scant regarding the multilevel factors associated with POUDs' willingness to initiate medication treatment for opioid use disorder (MOUD) while in prison and their continued engagement in treatment after release. Furthermore, rural and urban populations have not been compared. The Geographic variation in Addiction Treatment Experiences (GATE) study seeks to identify multilevel factors (ie, individual, personal network, and structural factors) influencing prison-based extended-release injectable naltrexone (XR-NTX) and buprenorphine initiation and will examine predictors of postrelease MOUD use and adverse outcomes (ie, relapse, overdose, recidivism) among both rural and urban POUDs. METHODS AND ANALYSIS This mixed methods study employs a social ecological framework. A prospective observational longitudinal cohort study is being conducted with 450 POUDs using survey and social network data collected in prison, immediately postrelease, 6 months postrelease and 12 months postrelease to identify multilevel rural-urban variation in key outcomes. In-depth qualitative interviews are being conducted with POUDs, prison-based treatment staff and social service clinicians. To maximise rigour and reproducibility, we employ a concurrent triangulation strategy, whereby qualitative and quantitative data contribute equally to the analysis and are used for cross-validation when examining scientific aims. ETHICS AND DISSEMINATION The GATE study was reviewed and approved by the University of Kentucky's Institutional Review Board prior to implementation. Findings will be disseminated through presentations at scientific and professional association conferences, peer-reviewed journal publications and a summary aggregate report submitted to the Kentucky Department of Corrections.
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Affiliation(s)
- Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, USA
| | - Evan Batty
- Department of Sociology, Center on Drug & Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Marisa Booty
- Department of Sociology, Center on Drug & Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Kate Eddens
- Department of Epidemiology & Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Hannah K Knudsen
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Brea Perry
- Department of Sociology, Irsay Family Research Institute, Indiana University, Bloomington, Indiana, USA
| | - Maria Rockett
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, USA
| | - Michele Staton
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
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Filteau MR, Green B, Kim F, McBride KA. 'It's the same thing as giving them CPR training': rural first responders' perspectives on naloxone. Harm Reduct J 2022; 19:111. [PMID: 36192736 PMCID: PMC9531424 DOI: 10.1186/s12954-022-00688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
The Substance Abuse and Mental Health Services Administration's (SAMHSA) Harm Reduction grant program expanded access to several harm reduction strategies to mitigate opioid overdose fatalities, including expanding access to naloxone. Interviews with first responders in a frontier and remote (FAR) state were conducted to understand their job responsibilities in relation to overdose response and prevention and their perceptions of training laypersons to administer naloxone. This study includes 22 interviews with law enforcement, EMS and/or fire personnel, and members of harm reduction-focused community organizations. The study finds widespread support for increasing access to naloxone and training laypersons in naloxone administration throughout Montana, due to rural first responders' inability to meet the needs of residents and an overall lack of resources to address addiction and the effects of fentanyl. Participants from harm reduction-focused community organizations convey support for training lay persons, but also illuminate that real and perceived cultural opposition to harm reduction strategies could reduce the likelihood that laypeople enroll in naloxone training. This study adds to the literature because it focuses on first responders in a FAR area that would benefit from layperson naloxone education and administration training due to its geographic expansiveness and the area's overall lack of access to medications for opioid use disorder or other treatment services. Expanding harm reduction approaches, like increasing access and training laypersons to administer naloxone, might be FAR residents' best chance for surviving an opioid overdose.
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Affiliation(s)
| | | | - Frances Kim
- JG Research and Evaluation, Bozeman, MT, USA
| | - Ki-Ai McBride
- Montana Department of Health and Human Services, Behavioral Health and Disabilities Disorders Division, Helena, MT, USA
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Childs K, Viglione J, Chapman JE, Drazdowski TK, McCart MR, Sheidow AJ. Delinquency, Substance Use, and Risky Sexual Behaviors among Youth who are involved in the Justice System and Predominantly Reside in Rural Communities: Patterns and Associated Risk Factors. JOURNAL OF CRIME AND JUSTICE 2022; 46:211-230. [PMID: 36970184 PMCID: PMC10035540 DOI: 10.1080/0735648x.2022.2103014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 07/05/2022] [Indexed: 10/15/2022]
Abstract
There is a significant gap in research examining the prevalence of problem behaviors among youth involved in the juvenile justice system in rural areas. The current study sought to address this gap by exploring the behavioral patterns of 210 youth who were on juvenile probation in predominantly rural counties and who were identified as having a substance use disorder. First, we examined the correlation among 7 problem behaviors representing different forms of substance use, delinquency, and sexual risk-taking and 8 risk factors related to recent service utilization, internalizing and externalizing difficulties, and social support networks. Then, we used latent class analysis (LCA) to identify distinct behavioral profiles based on the observed problem behaviors. LCA identified a 3-class model representing distinct groups labeled Experimenting (70%), Polysubstance Use + Delinquent Behaviors (24%), and Diverse Delinquent Behaviors (6%). Finally, we assessed differences (i.e., ANOVA, χ2) in each risk factor across the behavioral profiles. Important similarities and differences in the association among the problem behaviors, behavioral profiles, and the risk factors were revealed. These findings underscore the need for an interconnected behavioral health model within rural juvenile justice systems that is able to address youths' multidimensional needs including criminogenic, behavioral, and physical health needs.
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Affiliation(s)
- Kristina Childs
- University of Central Florida, Department of Criminal Justice
| | - Jill Viglione
- University of Central Florida, Department of Criminal Justice
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Community coalition and key stakeholder perceptions of the community opioid epidemic before an intensive community-level intervention. J Subst Abuse Treat 2022; 138:108731. [DOI: 10.1016/j.jsat.2022.108731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/20/2021] [Accepted: 01/19/2022] [Indexed: 12/19/2022]
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Khanra S, Singh U, Munda SK, Das B. Demographic and clinical profile of women receiving inpatient treatment at a deaddiction unit of a psychiatric hospital in India: Five years' observation. Ind Psychiatry J 2022; 31:177-180. [PMID: 35800856 PMCID: PMC9255629 DOI: 10.4103/ipj.ipj_84_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/17/2021] [Accepted: 06/26/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Sourav Khanra
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Ujjwal Singh
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Sanjay Kumar Munda
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Basudeb Das
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Green B, Rhubart DC, Filteau MR. Barriers for Implementing the Hub and Spoke Model to Expand Medication for Opioid Use Disorder: A Case Study of Montana. Subst Abuse 2021; 15:11782218211039781. [PMID: 34483660 PMCID: PMC8411614 DOI: 10.1177/11782218211039781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/28/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE Access to medication for opioid use disorder (MOUD) varies across the rural-urban continuum. The Hub & Spoke Model (H&S) emerged to address these gaps in service whereby hubs with staff expertise in MOUD support delivery of specialized care to a network of spoke locations, often located in rural communities with workforce shortages. This paper presents a case study of efforts to implement the hub and spoke model in a frontier and rural (FAR) state: Montana. METHODS The primary data are structured interviews with 65 MOUD program staff in hub and spoke locations within Montana. Both inductive and deductive coding were used to analyze the transcripts. FINDINGS Using the H&S structure to expand access to MOUD in Montana led to mixed results. There were consistent themes identified in the interviews about the reasons why hubs struggled to successfully recruit spokes, including (1) geographic barriers, (2) a lack of interest among medical providers, (3) fears about excessive demand, (4) concerns about the financial viability of the model, and (5) a preference for informal technical assistance rather than a formal H&S relationship. In addition to these 5 themes, efforts to implement H&S across different medical systems were unsuccessful, whereas the H&S model worked more effectively when H&S locations were within the same organization. CONCLUSION This case study identified limits to the H&S model utility in supporting states' abilities to expand access to MOUD treatment and offers suggestions for adapting it to accommodate variation across divergent rural contexts. We conclude with recommendations for strategies that may assist in expansion of MOUD in rural communities that are like those found in Montana.
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Blue H, Dahly A, Chhen S, Lee J, Shadiow A, Van Deelen AG, Palombi LC. Rural Emergency Medical Service Providers Perceptions on the Causes of and Solutions to the Opioid Crisis: A Qualitative Assessment. J Prim Care Community Health 2021; 12:2150132720987715. [PMID: 33430686 PMCID: PMC7809525 DOI: 10.1177/2150132720987715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The continuing opioid crisis poses unique challenges to remote and often under-resourced rural communities. Emergency medical service (EMS) providers serve a critical role in responding to opioid overdose for individuals living in rural or remote areas who experience opioid overdoses. They are often first at the scene of an overdose and are sometimes the only health care provider in contact with an overdose patient who either did not survive or refused additional care. As such, EMS providers have valuable perspectives to share on the causes and consequences of the opioid crisis in rural communities. Methods: EMS providers attending a statewide EMS conference serving those from greater Minnesota and surrounding states were invited to take a 2-question survey asking them to reflect upon what they believed to be the causes of the opioid crisis and what they saw as the solutions to the opioid crisis. Results were coded and categorized using a Consensual Qualitative Research approach. Results: EMS providers’ perceptions on causes of the opioid crisis were categorized into 5 main domains: overprescribing, ease of access, socioeconomic vulnerability, mental health concerns, and lack of resources and education. Responses focused on solutions to address the opioid crisis were categorized into 5 main domains: need for increased education, enhanced opioid oversight, increased access to treatment programs, alternative therapies for pain management, and addressing socioeconomic vulnerabilities. Conclusion: Along with the recognition that the opioid crisis was at least partially caused by overprescribing, rural EMS providers who participated in this study recognized the critical role of social determinants of health in perpetuating opioid-related harm. Participants in this study reported that education and increased access to treatment facilities and appropriate pain management, along with recognition of the role of social determinants of health in opioid dependency, were necessary steps to address the opioid crisis.
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Affiliation(s)
| | | | | | - Julie Lee
- University of Minnesota, Duluth, MN, USA
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Bensley KMK, Kerr WC, Barnett SB, Mulia N. Postmortem screening of opioids, benzodiazepines, and alcohol among rural and urban suicide decedents. J Rural Health 2021; 38:77-86. [PMID: 33817837 DOI: 10.1111/jrh.12574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Fatal suicides involving opioids are increasingly common, particularly in rural areas. As co-use of opioids with other substances contributes significantly to mortality risk, we examined whether positive screens for opioids with other substances is more prevalent among rural versus urban suicide deaths, as this could have implications for public health strategies to reduce overdose suicides. METHODS Data from all states reporting opioid-related overdose suicides in the National Violent Death Reporting System from 2012 to 2015 were used. Relative risk ratios were obtained using multinomial logistic regression, comparing opioid-only to (1) opioid and alcohol, (2) opioid and benzodiazepines, and (3) opioid, alcohol, and benzodiazepines suicides across rurality. Models were fit using robust standard errors and fixed effects for year of death, adjusting for individual, county, and state-level covariates. FINDINGS There were 3,781 opioid-overdose suicide decedents (42% female) tested for all 3 substances during the study period. Unadjusted prevalence of positive screens in decedents varied across rurality (P = .022). Urban decedents were more likely to test positive for opioids alone, while rural decedents were more to likely test positive for opioids and benzodiazepines. CONCLUSIONS Rural suicides are associated with increased opioid and benzodiazepine positive screens. These findings suggest the need for rural-focused interventions to support appropriate co-prescribing, better health education for providers about risks associated with drug mixing, and more linkages with mental health services.
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Affiliation(s)
- Kara Marie Kubiak Bensley
- School of Public Health, University of California, Berkeley, California, USA.,Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Sarah Beth Barnett
- School of Public Health, University of California, Berkeley, California, USA.,Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
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El-Akkad SED, Hayashi K, Dong H, Day A, McKendry R, Kaur G, Barrios R, Debeck K, Milloy MJ, Ti L. Migration Patterns from an Open Illicit Drug Scene and Emergency Department Visits among People Who Use Illicit Drugs in Vancouver, Canada. Subst Use Misuse 2021; 56:1837-1845. [PMID: 34378487 PMCID: PMC8855781 DOI: 10.1080/10826084.2021.1958849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND People who use illicit drugs (PWUD) experience various adverse health outcomes leading to increased healthcare service utilization. PWUD are also a highly mobile population which poses challenges to healthcare delivery. The objective of this study was to identify migration patterns from the Downtown Eastside (DTES), an urban illicit drug scene in Vancouver and to estimate the impact of different migration patterns on two outcomes: a) emergency department (ED) visits and b) ED visits resulting in inpatient admission among PWUD. METHODS Three prospective cohorts of PWUD in Vancouver were linked with regional ED data. We defined the optimal number of trajectory groups that best represented distinct patterns of migration from Vancouver's DTES using a latent class growth analysis. Then, generalized estimating equations were used to estimate the effect of migration patterns on the two ED outcomes. RESULTS Four distinct migration trajectory patterns were identified among the 1210 included participants: PWUD who consistently lived in the DTES, those who migrated out of DTES early, those who migrated out of DTES late, and those who frequently revisited the DTES. Participants who frequently revisited the DTES had higher odds of an ED visit (adjusted odds ratio = 1.62; 95% confidence interval: 1.28-2.06). There was no significant association between migration patterns and inpatient admission. CONCLUSIONS We found that PWUD who frequently revisited the DTES were more likely to have utilized the ED, suggesting that there may be a subgroup of PWUD who are at increased risk of experiencing negative health outcomes.Supplemental data for this article is available online at 10.1080/10826084.2021.1958849.
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Affiliation(s)
- Saif-El-Din El-Akkad
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use (BCCSU), Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use (BCCSU), Vancouver, BC, Canada
| | - Andrew Day
- Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | | | - Gaganpreet Kaur
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Kora Debeck
- British Columbia Centre on Substance Use (BCCSU), Vancouver, BC, Canada.,School of Public Policy, Simon Fraser University, Burnaby, BC, Canada
| | - M-J Milloy
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.,British Columbia Centre on Substance Use (BCCSU), Vancouver, BC, Canada
| | - Lianping Ti
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.,British Columbia Centre on Substance Use (BCCSU), Vancouver, BC, Canada
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15
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Snell-Rood C, Willging C, Showalter D, Peters H, Pollini RA. System-level factors shaping the implementation of “hub and spoke” systems to expand MOUD in rural areas. Subst Abus 2020; 42:716-725. [DOI: 10.1080/08897077.2020.1846149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Claire Snell-Rood
- University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - David Showalter
- Department of Sociology, University of California Berkeley, Berkeley, California, USA
| | - Hannah Peters
- University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Robin A. Pollini
- West Virginia University School of Public Health, Morgantown, West Virginia, USA
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16
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Nolte K, Drew AL, Friedmann PD, Romo E, Kinney LM, Stopka TJ. Opioid initiation and injection transition in rural northern New England: A mixed-methods approach. Drug Alcohol Depend 2020; 217:108256. [PMID: 32947174 PMCID: PMC7769168 DOI: 10.1016/j.drugalcdep.2020.108256] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 08/14/2020] [Accepted: 08/22/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND In rural northern New England, located in the northeastern United States, the overdose epidemic has accelerated with the introduction of fentanyl. Opioid initiation and transition to opioid injection have been studied in urban settings. Little is known about opioid initiation and transition to injection drug use in rural northern New England. METHODS This mixed-methods study characterized opioid use and drug injection in 11 rural counties in Massachusetts, Vermont, and New Hampshire between 2018 and 2019. People who use drugs completed audio computer-assisted self-interview surveys on substance use and risk behaviors (n = 589) and shared personal narratives through in-depth interviews (n = 22). The objective of the current study is to describe initiation of opioid use and drug injection in rural northern New England. RESULTS Median age of first injection was 22 years (interquartile range 18-28 years). Key themes from in-depth interviews that led to initiating drug injection included normalization of drug use in families and communities, experiencing trauma, and abrupt discontinuation of an opioid prescription. Other factors that led to a transition to injecting included lower cost, increased effect/ rush, greater availability of heroin/ fentanyl, and faster relief of withdrawal symptoms with injection. CONCLUSIONS Trauma, normalization of drug use, over-prescribing of opioids, and abrupt discontinuation challenge people who use drugs in rural northern New England communities. Inadequate opioid tapering may increase transition to non-prescribed drug use. The extent and severity of traumatic experiences described highlights the importance of enhancing trauma-informed care in rural areas.
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Affiliation(s)
- Kerry Nolte
- Department of Nursing, College of Health and Human Services, University of New Hampshire, Hewitt Hall, 4 Library Way, Durham, NH, 03824, USA.
| | - Aurora L. Drew
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, USA,Synergy Center for Translational Science, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Peter D. Friedmann
- Baystate Office of Research, University of Massachusetts Medical School, 3601 Main Street, 3rdFloor, Springfield, MA, 01199, USA
| | - Eric Romo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Linda M. Kinney
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
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17
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Tran L, Tran P, Tran L. Influence of Rurality on HIV Testing Practices Across the United States, 2012-2017. AIDS Behav 2020; 24:404-417. [PMID: 30762188 DOI: 10.1007/s10461-019-02436-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In the US, HIV testing has been key in the identification of new HIV cases, allowing for the initiation of antiretroviral treatment and a reduction in disease transmission. We consider the influence of living in a rural area (rurality) on HIV testing between different US regions and states as existing work in this area is limited. Using the 2012-2017 Behavioral Risk Factor Surveillance Systems surveys, we explored the independent role of rurality on having ever been tested for HIV and having a recent HIV test at the national, regional, and state levels by calculating average adjusted predictions (AAPs) and average marginal effects (AMEs). Suburban and urban areas had higher odds and AAPs of having ever been tested for HIV and having a recent HIV test compared to rural areas across the US. The Midwest had the lowest AAPs for both having ever been tested for HIV (17.57-20.32%) and having a recent HIV test (37.65-41.14%) compared to other regions. For both questions on HIV testing, regions with the highest AAPs had the greatest rural-urban differences in probabilities and regions with the lowest AAPs had the smallest rural-urban difference in probabilities. The highest rural-urban testing disparities were observed in states with high AAPs for HIV testing. HIV testing estimates were higher in urban compared to rural areas at the national, regional, and state level. This study examines the isolated influence of rurality on HIV testing and identifies specific US areas where future efforts to increase HIV testing should be directed to.
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18
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Ti L, Dong H, Day A, McKendry R, DeBeck K, Bingham B, Milloy MJ, Barrios R, Hayashi K. Longitudinal migration patterns from an open illicit drug scene among people who use illicit drugs in Vancouver, Canada. J Subst Abuse Treat 2019; 107:17-23. [PMID: 31757260 PMCID: PMC6892597 DOI: 10.1016/j.jsat.2019.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 09/23/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022]
Abstract
The objective of this study was to identify migration patterns from an open illicit drug scene (the Downtown Eastside [DTES] neighborhood) and describe factors associated with these migration patterns. Data were derived from three cohorts of people who use illicit drugs in Vancouver, Canada. Defined using latent class growth analysis, we identified four distinct migration trajectory groups: 1) consistently living in the DTES (47.8%); 2) early migration out, with a median time of migrating out of DTES of 5.3 months (21.5%); 3) late migration out, with a median time of migrating out of DTES of 38.0 months (20.1%); and 4) frequent revisit back-and-forth to DTES (10.6%). In a multivariable model, compared to the "consistently living in the DTES" group, factors associated with the "frequent revisit" group included being enrolled in non-pharmacological addiction treatment and having an HCV-positive serostatus. Factors associated with the "early migration out" group included being enrolled in detoxification or in other non-pharmacological addiction treatment, later calendar year, being on income assistance, living in a single room occupancy hotel, and having an HCV-positive serostatus. These findings point to the need for appropriate distribution of services in order to meet the needs of this population.
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Affiliation(s)
- Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Andrew Day
- Vancouver Coastal Health Authority, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Rachael McKendry
- Vancouver Coastal Health Authority, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada
| | - Brittany Bingham
- Vancouver Coastal Health Authority, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Rolando Barrios
- Vancouver Coastal Health Authority, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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19
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Cucciare MA, Ounpraseuth ST, Curran GM, Booth BM. Predictors of mental health and substance use disorder treatment use over 3 years among rural adults using stimulants. Subst Abus 2019; 40:363-370. [PMID: 30810499 DOI: 10.1080/08897077.2018.1547809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Persons using substances, living in rural communities, tend to underutilize mental health (MH) and substance use disorder (SUD) treatment compared with their urban peers. However, no studies have examined longitudinal predictors of MH and SUD treatment use among rural persons using stimulants. Methods: Data were collected through interviews conducted between 2002 and 2008 from a natural history study of 710 adults using stimulants and living in rural counties of Arkansas, Kentucky, and Ohio. Each study site recruited participants using respondent-driven sampling (RDS). Participants were adults, not in drug treatment, and reporting past-30-day use of methamphetamine, crack cocaine, or powder cocaine. Study participants completed face-to-face baseline assessments and follow-up interviews using computer-assisted personal interviews. Follow-up interviews were conducted at 6-month intervals for 3 years. Results: Our results show that being male, nonwhite, and having a prior lifetime history of MH or SUD treatment use were associated with lower odds of using MH and SUD treatment over time; having medical insurance and living in a state with potentially greater availability of MH and SUD treatment were associated with higher odds of using MH and SUD treatment over the 3-year period. Further, reporting greater legal problems and alcohol severity were associated with greater odds of using MH and SUD care, whereas greater employment problems was associated with higher odds of SUD but not MH treatment use. Conclusions: Findings from this study could be used to inform clinical and public health strategies for improving linkage to MH and SUD care in this population. Our findings also highlight the importance of having medical insurance as a potential facilitator to utilizing SUD care in this population and support the need for health care policies that increase the ability of rural adults who use stimulants to pay for such services.
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Affiliation(s)
- Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Central Arkansas Veterans Affairs Healthcare System, Center for Mental Health Care and Outcomes Research, North Little Rock, Arkansas, USA.,VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, Arkansas, USA
| | - Songthip T Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Geoffrey M Curran
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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20
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Smith KE, Stoops WW. Synthetic Cathinone Use Among Polysubstance Users: Indirect Indicator of Indiscriminate Drug Taking or Preferred Drug of Abuse? JOURNAL OF DRUG ISSUES 2019. [DOI: 10.1177/0022042619826079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A survey pertaining to synthetic cathinone (SC) use was completed by 499 polysubstance users enrolled in a residential recovery program in the Southeastern United States. Of the final sample, 28% reported ever SC use. SC-users, compared with nonusers, were more often younger (32.7 vs. 36.0, p = .001), White (93.4% vs. 80.8%, p = .001), and on probation/parole since 2010 (80.9% vs. 70.9%, p = .032). SC-users evidenced extensive drug histories and were less likely to be enrolled in an urban-based program, compared to a rural, Appalachian-based program (73.8% vs. 86.6%, p = .001). Use of synthetic cannabinoids (adjusted odds ratio [AOR] = 1.9, p = .044), kratom (AOR = 1.7, p = .045), and inhalants (AOR = 2.3, p = .001) were significantly associated with SC use. Approximately 23% of SC-users preferred SCs to amphetamines or cocaine; however, only 3.6% ranked SC as their most preferred drug. Past-year SC use declined to 6.6%. Among polysubstance users in this sample, SC use may be a potential indicator of versatile and indiscriminate drug-taking.
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Affiliation(s)
- Kirsten E. Smith
- University of Kentucky, Lexington, USA
- University of Louisville, KY, USA
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21
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Bunting AM, Oser CB, Staton M, Eddens KS, Knudsen H. Clinician identified barriers to treatment for individuals in Appalachia with opioid use disorder following release from prison: a social ecological approach. Addict Sci Clin Pract 2018; 13:23. [PMID: 30509314 PMCID: PMC6278109 DOI: 10.1186/s13722-018-0124-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/21/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The non-medical use of opioids has reached epidemic levels nationwide, and rural areas have been particularly affected by increasing rates of overdose mortality as well as increases in the prison population. Individuals with opioid use disorder (OUD) are at increased risk for relapse and overdose upon reentry to the community due to decreased tolerance during incarceration. It is crucial to identify barriers to substance use disorder treatment post-release from prison because treatment can be particularly difficult to access in resource-limited rural Appalachia. METHODS A social ecological framework was utilized to examine barriers to community-based substance use treatment among individuals with OUD in Appalachian Kentucky following release from prison. Semi-structured qualitative interviews with 15 social service clinicians (SSCs) employed by the Department of Corrections were conducted to identify barriers at the individual, interpersonal, organizational/institutional level, community, and systems levels. Two independent coders conducted line-by-line coding to identify key themes. RESULTS Treatment barriers were identified across the social ecological spectrum. At the individual-level, SSCs highlighted high-risk drug use and a lack of motivation. At the interpersonal level, homogenous social networks (i.e., homophilious drug-using networks) and networks with limited treatment knowledge inhibited treatment. SSC's high case load and probation/parole officer's limited understanding of treatment were organizational/institutional barriers. Easy access to opioids, few treatment resources, and a lack of community support for treatment were barriers at the community level. SSC's noted system-level barriers such as lack of transportation options, cost, and uncertainty about the implementation of the Affordable Care Act. CONCLUSIONS More rural infrastructure resources as well as additional education for family networks, corrections staff, and the community at large in Appalachia are needed to address barriers to OUD treatment. Future research should examine barriers from the perspective of other key stakeholders (e.g., clients, families of clients) and test interventions to increase access to OUD treatment.
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Affiliation(s)
| | - Carrie B. Oser
- Department of Sociology, University of Kentucky, Lexington, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, USA
| | - Michele Staton
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, USA
- Department of Behavioral Science, University of Kentucky, Lexington, USA
| | - Katherine S. Eddens
- Indiana University Network Science Institute, Indiana University, Bloomington, USA
| | - Hannah Knudsen
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, USA
- Department of Behavioral Science, University of Kentucky, Lexington, USA
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22
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Opioid-related mortality in rural America: Geographic heterogeneity and intervention strategies. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 57:119-129. [DOI: 10.1016/j.drugpo.2018.04.011] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 03/09/2018] [Accepted: 04/16/2018] [Indexed: 01/27/2023]
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23
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Palombi LC, St Hill CA, Lipsky MS, Swanoski MT, Lutfiyya MN. A scoping review of opioid misuse in the rural United States. Ann Epidemiol 2018; 28:641-652. [PMID: 29921551 DOI: 10.1016/j.annepidem.2018.05.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/09/2018] [Accepted: 05/24/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study is a scoping review of the original research literature onthe misuse of opioids in the rural United States (US) and maps theliterature of interest to address the question: What does theoriginal research evidence reveal about the misuse of opioids inrural US communities? METHODS This study used a modified preferred reporting items for systematicreviews and meta-analyses (PRISMA) approach which is organized byfive distinct elements or steps: beginning with a clearly formulatedquestion, using the question to develop clear inclusion criteria toidentify relevant studies, using an approach to appraise the studiesor a subset of the studies, summarizing the evidence using anexplicit methodology, and interpreting the findings of the review. RESULTS The initial search yielded 119 peer reviewed articles and aftercoding, 41 papers met the inclusion criteria. Researcher generatedsurveys constituted the most frequent source of data. Most studieshad a significant quantitative dimension to them. All the studieswere observational or cross-sectional by design. CONCLUSIONS This analysis found an emerging research literature that hasgenerated evidence supporting the claim that rural US residents andcommunities suffer a disproportionate burden from the misuseof opioidscompared to their urban or metropolitan counterparts.
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Affiliation(s)
- Laura C Palombi
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | | | | | - Michael T Swanoski
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | - M Nawal Lutfiyya
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Minneapolis, MN.
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24
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Staton M, Ciciurkaite G, Oser C, Tillson M, Leukefeld C, Webster JM, Havens JR. Drug Use and Incarceration among Rural Appalachian Women: Findings From a Jail Sample. Subst Use Misuse 2018; 53:931-941. [PMID: 29161158 PMCID: PMC6121714 DOI: 10.1080/10826084.2017.1385631] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND/OBJECTIVE The purpose of this paper is to examine drug use and incarceration history among rural Appalachian women. METHODS This study involved random selection, screening, and interviews with rural women from local jails in Appalachia. RESULTS Of the women randomly selected and screened, 97% met criteria for substance use intervention. Significant factors associated with incarceration history included age, education, custody status, and mental health. A significant interaction was observed between male sex partners and drug use on incarceration history. CONCLUSIONS Study findings suggest that the drug/crime relationship among rural Appalachian women is associated with their high-risk home environment, partner relationships, and mental health. Specifically, in addition to drug use, factors such as family and child relationships, anxiety, victimization, and relationships with partners should also be considered in the trajectory of criminal careers among rural Appalachian women.
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Affiliation(s)
- Michele Staton
- a Department of Behavioral Science , University of Kentucky , College of Medicine, Lexington , Kentucky , USA
| | - Gabriele Ciciurkaite
- b Department of Sociology , Social Work and Anthropology, Utah State University , Logan , Utah , USA
| | - Carrie Oser
- c Department of Sociology , University of Kentucky , Lexington , Kentucky , USA
| | - Martha Tillson
- d Department of Behavioral Science, Center on Drug and Alcohol Research , University of Kentucky , Lexington , Kentucky , USA
| | - Carl Leukefeld
- d Department of Behavioral Science, Center on Drug and Alcohol Research , University of Kentucky , Lexington , Kentucky , USA
| | - J Matthew Webster
- d Department of Behavioral Science, Center on Drug and Alcohol Research , University of Kentucky , Lexington , Kentucky , USA
| | - Jennifer R Havens
- d Department of Behavioral Science, Center on Drug and Alcohol Research , University of Kentucky , Lexington , Kentucky , USA
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25
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Finlay AK, Harris AHS, Rosenthal J, Blue-Howells J, Clark S, Flatley B, Timko C. Justice Involvement and Treatment Use Among Rural Veterans. RURAL MENTAL HEALTH 2018; 42:46-59. [PMID: 30271523 PMCID: PMC6157744 DOI: 10.1037/rmh0000092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Veterans in rural areas and veterans involved in the criminal justice system have experienced less access to, and use of, health care. However, there is limited information on the treatment needs and health care access of justice-involved veterans who live in rural areas. This study used national Veterans Health Administration data from fiscal year 2014 to examine the interactive effect of rural/urban residence and justice involvement on mental health and substance use disorder treatment entry among veterans diagnosed with mental health or substance use disorders. Of veterans residing in rural areas, 15,328 (2.5%) were justice-involved and 607,819 (97.5%) veterans had no known justice involvement. Among veterans in urban areas, 54,525 (4.3%) were justice-involved and 1,213,766 (95.7%) had no known justice involvement. Rural residence was associated with lower access to mental health or substance use disorder treatment in the non-justice-involved sample but not the justice-involved sample. Justice-involvement was associated with higher odds of entering mental health or substance use disorder treatment for veterans in rural and in urban areas. Substance use disorder treatment entry could be improved for all veterans, particularly rural veterans who are not justice-involved. Telehealth, outreach services, and integrated treatment may help address challenges to treatment entry experienced by rural veterans and justice-involved veterans.
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Affiliation(s)
- Andrea K Finlay
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, and National Center on Homelessness Among Veterans, Department of Veterans Affairs
| | - Alex H S Harris
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, and Department of Surgery, Stanford University School of Medicine
| | - Joel Rosenthal
- Veterans Justice Programs, Department of Veterans Affairs
| | | | - Sean Clark
- Veterans Justice Programs, Department of Veterans Affairs
| | | | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
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26
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Victor G, Kheibari A, Staton M, Oser C. Appalachian Women's Use of Substance Abuse Treatment: Examining the Behavioral Model for Vulnerable Populations. JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2018; 18:192-213. [PMID: 30853861 PMCID: PMC6405208 DOI: 10.1080/1533256x.2018.1450264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The Gelberg-Andersen Behavioral Model for Vulnerable Populations was applied to understand vulnerable Appalachian women's (N = 400) utilization of addiction treatment. A secondary data analyses included multiple multivariate analyses. Strongest correlates of treatment utilization included ever injecting drugs (OR = 2.77), limited availability of substance abuse treatment facilities (OR = 2.03), and invalidated violence abuse claims (OR = 2.12). This study contributes theory-driven research to the greater social work addiction literature by confirming that vulnerable domains related to substance abuse treatment utilization warrant unique considerations compared to non-vulnerable domains. Findings also highlight the importance of understanding the unique role that cultural factors play in treatment utilization among Appalachian women. Inferences relevant to clinicians and policymakers are discussed.
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Affiliation(s)
- Grant Victor
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Athena Kheibari
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Michele Staton
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Carrie Oser
- College of Sociology, University of Kentucky, Lexington, KY, USA
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27
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Staton M, Ciciurkaite G, Havens J, Tillson M, Leukefeld C, Webster M, Oser C, Peteet B. Correlates of Injection Drug Use Among Rural Appalachian Women. J Rural Health 2017; 34:31-41. [PMID: 28685884 DOI: 10.1111/jrh.12256] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/01/2017] [Accepted: 05/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Limited research has focused on correlates of injection drug use (IDU) among high-risk subgroups of drug users, particularly women, who may be at increased risk for transmission of infectious diseases such as HIV and Hepatitis C. The purpose of this study is to better understand the contextual and health correlates of IDU among women living in rural Appalachia by examining (1) differences between injectors and noninjectors, and (2) the unique correlates of recent IDU and past IDU. METHODS This study involved random selection, screening, and face-to-face interviews with 400 rural Appalachian women from jails in one state. Analyses included descriptive statistics, multinomial logistic regression, and stepwise regression to identify significant correlates of recent IDU and past IDU compared to never injecting. RESULTS Findings indicated that 75.3% of this randomly selected sample reported lifetime injection of drugs. Contextual factors including drug use severity (RRR = 8.66, P < .001), more male sex partners (RRR = 1.01, P < .05), and having injecting partners (RRR = 7.60, P < .001) were robust correlates of recent injection practices. CONCLUSIONS This study makes an important contribution to understanding factors associated with IDU among rural Appalachian women drug users, which are strongly associated with both relational and health factors. Study findings on the specific factors associated with IDU risk have important implications for tailoring and targeting interventions that should include a focus on the relationship context reducing high-risk injection practices.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Gabriele Ciciurkaite
- Department of Sociology, Social Work and Anthropology, Utah State University, Logan, Utah
| | - Jennifer Havens
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Martha Tillson
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Carl Leukefeld
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Matthew Webster
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Carrie Oser
- Department of Sociology, University of Kentucky, Lexington, Kentucky
| | - Bridgette Peteet
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio
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Cucciare MA, Han X, Timko C, Zaller N, Kennedy KM, Booth BM. Correlates of three-year outpatient medical care use among rural stimulant users. J Subst Abuse Treat 2017; 77:6-12. [PMID: 28476274 DOI: 10.1016/j.jsat.2017.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/10/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
Abstract
Outpatient medical care (OMC) settings are a care context in which effective management of unhealthy substance use can occur. However, no studies have documented rates of OMC use and characteristics of OMC use among rural substance users. This study sought to examine the rates and frequency of OMC use in a sample of rural drug users over a three-year period. We also explored characteristics of participants associated with use of OMCs over time. Data were collected from June 2005 to September 2007 from a natural history study of 710 stimulant users living in rural communities. Participants were adults, not in drug treatment, and reporting recent methamphetamine, crack cocaine or powder cocaine use. Between 34 and 39% of participants reported any use of an OMC over the three-year follow-up period, with a mean average number of visits ranging from one to two at each follow-up. Having medical insurance, reporting any use of substance use disorder-related care (including formal substance use treatment or mutual-help groups), and higher Addiction Severity Index (ASI) medical and psychiatric composite scores were associated with greater odds of any OMC use and higher frequency of OMC use over time. Being male and having higher ASI alcohol and drug composite scores were associated with lower odds of any OMC use and lower frequency of OMC use. Our findings support the importance of public health efforts to increase OMC use among male rural drug users and those with more severe drug and alcohol use, the important role(s) of Federally Qualified Health Centers and other OMCs in rural communities that serve those with low rates of health insurance, and the need for public health efforts to increase the use of OMCs among rural drug users not experiencing more severe medical or psychiatric health problems.
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Affiliation(s)
- Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR 72205, USA.
| | - Xiaotong Han
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR 72205, USA
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Nickolas Zaller
- College of Public Health, Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Kristina M Kennedy
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Department of Psychology and Counseling, University of Central Arkansas, Conway, AR 72035, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Bond Edmond M, Aletraris L, Roman PM. Rural substance use treatment centers in the United States: an assessment of treatment quality by location. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 41:449-57. [PMID: 26337202 DOI: 10.3109/00952990.2015.1059842] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND While previous research has added to the understanding of rural residents' unique health challenges, much remains to be learned about the provision of substance use disorder (SUD) treatment in rural areas. A key question is difference in structural resources and quality of care between rural and urban treatment centers. OBJECTIVE To examine differences in treatment quality in rural and urban centers and to determine if differences in treatment quality are contextualized by centers' structural resources. METHODS Utilizing combined data from two representative samples of SUD treatment centers (n = 591), we used a series of multivariate regressions to analyze the association between center rurality and various indicators of structural characteristics and treatment quality. Interaction effects were further examined between structural characteristics and treatment quality indicators. RESULTS We found that structural and quality differences between rural and urban treatment centers were present. Rural centers had reduced access to highly educated counselors, were more likely to be non-profit and dependent on public funding, offered fewer wraparound services, and had less diverse specialized treatment options. Our results also indicated that rural centers were less likely to prescribe buprenorphine as part of their treatment but were more likely to employ nursing staff and offer specialized treatment for adolescents. Rural center access to a physician contextualized the association between center rurality and the more limited provision of wraparound services. CONCLUSION Our findings suggest that treatment quality differs between urban and rural centers in complex ways that are subject to resource availability.
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Affiliation(s)
- Mary Bond Edmond
- a Owens Institute for Behavioral Research, University of Georgia , Athens , GA , USA
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Cucciare MA, Han X, Curran GM, Booth BM. Associations Between Religiosity, Perceived Social Support, and Stimulant Use in an Untreated Rural Sample in the U.S.A. Subst Use Misuse 2016; 51:823-34. [PMID: 27096554 PMCID: PMC4962696 DOI: 10.3109/10826084.2016.1155611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Religiosity and perceived social support (SS) may serve as protective factors for more severe substance use in adults. OBJECTIVES This study sought to examine whether aspects of religiosity and SS are associated with longitudinal reductions in stimulant use over three years in an untreated sample of rural drug users. METHODS Respondent-driven sampling was used to recruit stimulant users (N = 710) from Arkansas, Kentucky, and Ohio. Follow-up interviews were conducted at 6-month intervals for 36 months. RESULTS Our bivariate findings indicate that higher religiosity was associated with lower odds and fewer days of methamphetamine and cocaine use. After controlling for covariates, higher religiosity was associated with fewer days of crack cocaine use, but more days of methamphetamine use among a small sample of users in the two final interviews. Higher SS from drug-users was also associated with higher odds and days of methamphetamine and powder cocaine use, while higher SS from nondrug users was associated with fewer days of methamphetamine use. CONCLUSIONS/IMPORTANCE Our bivariate findings suggest that higher levels of religiosity may be helpful for some rural individuals in reducing their drug use over time. However, our multivariate findings suggest a need for further exploration of the potential effects of religiosity on longer-term drug use, especially among those who continue to use methamphetamine and/or remain untreated. Our findings also highlight the potential deleterious effect of SS from drug users on the likelihood and frequency of methamphetamine and powder cocaine use over time among untreated rural drug users.
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Affiliation(s)
- Michael A Cucciare
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.,b Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.,c VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA
| | - Xiaotong Han
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.,c VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA
| | - Geoffrey M Curran
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.,b Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.,d Department of Pharmacy Practice , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Brenda M Booth
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
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Chan YF, Lu SE, Howe B, Tieben H, Hoeft T, Unützer J. Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural-Urban Variations. J Gen Intern Med 2016; 31:215-222. [PMID: 26269130 PMCID: PMC4720630 DOI: 10.1007/s11606-015-3488-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/16/2015] [Accepted: 07/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use problems are addressed in rural primary care settings. OBJECTIVE To examine rural-urban variations in screening and monitoring primary care- based patients for substance use problems in a state-wide mental health integration program. DESIGN This was an observational study using patient registry. SUBJECTS The study included adult enrollees (n = 15,843) with a mental disorder from 133 participating community health clinics. MAIN OUTCOMES We measured whether a standardized substance use instrument was used to screen patients at treatment entry and to monitor symptoms at follow-up visits. KEY RESULTS While on average 73.6 % of patients were screened for substance use, follow-up on substance use problems after initial screening was low (41.4 %); clinics in small/isolated rural settings appeared to be the lowest (13.6 %). Patients who were treated for a mental disorder or substance abuse in the past and who showed greater psychiatric complexities were more likely to receive a screening, whereas patients of small, isolated rural clinics and those traveling longer distances to the care facility were least likely to receive follow-up monitoring for their substance use problems. CONCLUSIONS Despite the prevalent substance misuse among patients with mental disorders, opportunities to screen this high-risk population for substance use and provide a timely follow-up for those identified as at risk remained overlooked in both rural and urban areas. Rural residents continue to bear a disproportionate burden of substance use problems, with rural-urban disparities found to be most salient in providing the continuum of services for patients with substance use problems in primary care.
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Affiliation(s)
- Ya-Fen Chan
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Shou-En Lu
- Department of Biostatistics, School of Public Health, Rutgers University, Newark, NJ, USA
| | - Bill Howe
- Department of Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - Hendrik Tieben
- School of Architecture, Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Theresa Hoeft
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jürgen Unützer
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Oser CB, Bunting AM, Pullen E, Stevens-Watkins D. African American Female Offender's Use of Alternative and Traditional Health Services After Re-Entry: Examining the Behavioral Model for Vulnerable Populations. J Health Care Poor Underserved 2016; 27:120-48. [PMID: 27133515 PMCID: PMC4855295 DOI: 10.1353/hpu.2016.0052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This is the first known study to use the Gelberg-Andersen Behavioral Model for Vulnerable Populations to predict African American women's use of three types of health services (alternative, hospitalization, and ambulatory) in the 18 months after release from prison. In the multivariate models, the most robust predictors of all three types of service utilization were in the vulnerable theoretical domains. Alternative health services were predicted by ethnic community membership, higher religiosity, and HIV/HCV. Hospitalizations were predicted by the lack of barriers to health care and disability. Ambulatory office visits were predicted by more experiences of gendered racism, a greater number of physical health problems, and HIV/HCV. Findings highlight the importance of cultural factors and HIV/HCV in obtaining both alternative and formal health care during community re-entry. Clinicians and policymakers should consider the salient role that the vulnerable domain plays in offender's accessing health services.
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Affiliation(s)
- Carrie B. Oser
- 1531 Patterson Office Tower, Department of Sociology, Center on Drug & Alcohol Research, University of Kentucky, Lexington, Kentucky, 40506. Phone: 859-257-6890. Fax: 859-323-0272
| | - Amanda M. Bunting
- 1505 Patterson Office Tower, Department of Sociology, University of Kentucky, Lexington, Kentucky, 40506. Phone: 859-257-6896. Fax: 859-323-0272
| | - Erin Pullen
- Indiana University Network Science Institute, Bloomington, Indiana, 47405. Phone: 231-878-8494. Fax: 812-855-0781
| | - Danelle Stevens-Watkins
- 245 Dickey Hall, Department of Educational, Counseling, and School Psychology, University of Kentucky, Lexington, Kentucky, 40506. Phone: 859-257-7889. Fax: 859-257-5662
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33
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Browne T, Priester MA, Clone S, Iachini A, DeHart D, Hock R. Barriers and Facilitators to Substance Use Treatment in the Rural South: A Qualitative Study. J Rural Health 2015; 32:92-101. [PMID: 26184098 DOI: 10.1111/jrh.12129] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Little qualitative research has examined factors associated with care in substance abuse treatment agencies in Southeastern rural communities. This study explored client- and agency stakeholder-perceived barriers and facilitators to substance use treatment delivery in southeastern rural communities. METHODS Group and individual interviews were conducted with 40 key stakeholders and 40 clients at 9 substance abuse agencies serving rural communities in a southeastern state. Qualitative thematic analysis was used to identify perceived barriers and facilitators to substance abuse services in rural communities. FINDINGS Four primary themes emerged from the client and stakeholder interviews as both barriers and facilitators: availability of services for individuals with substance use disorders; access to the current technology for client services and agency functioning; cost of services; and stigma. CONCLUSIONS This study identifies novel barriers and facilitators to substance use care in the rural South and highlights essential areas for consideration when developing and implementing substance use care in this geographic region. These findings can be used as guidelines to provide better care to individuals with substance use disorders living in rural communities.
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Shaw MR, Grant T, Barbosa‐Leiker C, Fleming SE, Henley S, Graham JC. Intervention with substance‐abusing mothers: Are there rural–urban differences? Am J Addict 2015; 24:144-152. [DOI: 10.1111/ajad.12155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 05/12/2014] [Accepted: 06/24/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Michele R. Shaw
- College of NursingWashington State UniversitySpokaneWashington
| | - Therese Grant
- Department of Psychiatry and Behavioral SciencesSchool of MedicineUniversity of WashingtonSeattleWashington
| | | | | | - Sandy Henley
- College of NursingWashington State UniversitySpokaneWashington
| | - J. Christopher Graham
- Department of Health Sciences AdministrationAlcohol and Drug Abuse InstituteUniversity of WashingtonSeattleWashington
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35
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Grahn R, Lundgren LM, Chassler D, Padyab M. Repeated entries to the Swedish addiction compulsory care system: a national register database study. EVALUATION AND PROGRAM PLANNING 2015; 49:163-171. [PMID: 25559948 DOI: 10.1016/j.evalprogplan.2014.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study identified and described specific client groups who have repeated entries to the Swedish addiction compulsory care system. Specifically, through the use of baseline data from the Swedish government Staten's Institutions Styrelse (SiS) database, for 2658 individuals who were assessed at their compulsory care intake interview by social workers in the national social welfare system between 2001 and 2009 the study identified the associations between specific predisposing, enabling and need characteristics and repeated addiction compulsory care entries. The logistic regression model identified that individuals whose children have been mandated to the child welfare system, who have experienced prior compulsory care including compulsory treatment through LVU (law (1990:52) with specific provision about care of young people under 18), and those who have been in prison are more likely to have two or more entries in the addiction compulsory care system compared to their counterparts. Individuals who have been mandated to compulsory care for their substance use disorder two or more times have significant multiple complex problems and repeated experiences of institutionalization. These individuals are a group in need of a well-coordinated and integrated system of aftercare services to reduce the likelihood of re-entry into addiction compulsory care.
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Affiliation(s)
- Robert Grahn
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden.
| | - Lena M Lundgren
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden; Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
| | - Deborah Chassler
- Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
| | - Mojgan Padyab
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden
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36
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Shaw MR, Grant T, Barbosa-Leiker C, Fleming SE, Henley S, Graham JC. Intervention with substance-abusing mothers: Are there rural-urban differences? Am J Addict 2014:n/a-n/a. [PMID: 25278087 DOI: 10.1111/j.1521-0391.2014.12155.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 05/12/2014] [Accepted: 06/24/2014] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine rural-urban differences among substance-abusing mothers enrolled in the Parent-Child Assistance Program (PCAP) from 1998 to 2008 in Washington State. METHODS This was a longitudinal study utilizing PCAP data reports of 773 women enrolled from 1998 to 2008. Differences across urban-rural PCAP participants were examined. RESULTS Rural participants were more likely to report alcohol use and binge drinking at program intake and at the 3-year program exit. In addition, throughout the program, rural women were less likely to complete outpatient substance abuse treatment compared to urban participants. Rural women also used less services during the last year including alcohol/drug support and mental health provider services. Findings are troubling when we consider that at program exit, rural participants also reported higher use of alcohol and more suicidal thoughts than those residing in urban areas. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Data presented indicate there are important differences between urban and rural residing participants. Findings highlight the importance of considering the barriers that rural or remote locations might create. Identifying community-specific needs of substance abusing pregnant or parenting women in both rural and urban settings is crucial for the successful development and improvement of treatment and intervention programs for this vulnerable population of women. (Am J Addict 2014;XX:1-9).
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Affiliation(s)
- Michele R Shaw
- College of Nursing, Washington State University, Spokane, Washington
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Pahl K, Brook JS, Zhang C, Brook DW. Psychosocial Predictors of Mental Health Service Utilization Among Women During their Mid-Sixties. J Behav Health Serv Res 2014; 43:143-54. [PMID: 24878632 DOI: 10.1007/s11414-014-9414-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This prospective study examined the longitudinal pathways to the utilization of mental health services among women in their mid-sixties. Earlier educational level, psychological symptoms, cigarette use, and physical diseases and later psychological symptoms were examined as predictors of mental health services utilization. The sample consisted of a prospective cohort of women (N = 511) who were followed from young adulthood (mean age = 32) to late midlife (mean age = 65). Using structural equation modeling, the results supported a mediational model showing that earlier low educational level and greater psychological symptoms predicted increased cigarette smoking. Cigarette smoking predicted later physical diseases and symptoms. Physical diseases and symptoms were related to financial difficulty and later psychological symptoms and, ultimately, the use of mental health services by women in the mid-sixties.
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Affiliation(s)
- Kerstin Pahl
- Department of Psychiatry, New York University School of Medicine, 215 Lexington Avenue, 15th Floor, New York, NY, 10016, USA
| | - Judith S Brook
- Department of Psychiatry, New York University School of Medicine, 215 Lexington Avenue, 15th Floor, New York, NY, 10016, USA.
| | - Chenshu Zhang
- Department of Psychiatry, New York University School of Medicine, 215 Lexington Avenue, 15th Floor, New York, NY, 10016, USA
| | - David W Brook
- Department of Psychiatry, New York University School of Medicine, 215 Lexington Avenue, 15th Floor, New York, NY, 10016, USA
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Pullen E, Oser C. Barriers to substance abuse treatment in rural and urban communities: counselor perspectives. Subst Use Misuse 2014; 49:891-901. [PMID: 24611820 PMCID: PMC3995852 DOI: 10.3109/10826084.2014.891615] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study is to compare rural and urban substance abuse counselors' perceptions of barriers to providing effective treatment services. Data were collected from 28 substance abuse counselors in Kentucky during four focus group sessions in 2008. Line-by-line coding and memoing were used by two raters on the transcribed data to isolate findings. The results of this study suggest that, though rural and urban counselors encounter similar constraints that hamper successful treatment outcomes, rural counselors are subject to special circumstances within their communities that present unique challenges to treatment efficacy. Novel contributions, implications, and limitations are also discussed.
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Affiliation(s)
- Erin Pullen
- Department of Sociology, University of Kentucky , Lexington, Kentucky , USA
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Staton-Tindall M, Duvall J, Stevens-Watkins D, Oser CB. The roles of spirituality in the relationship between traumatic life events, mental health, and drug use among African American women from one southern state. Subst Use Misuse 2013; 48:1246-57. [PMID: 24041186 PMCID: PMC3878434 DOI: 10.3109/10826084.2013.799023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study examines the role of spirituality as a moderator of the relationship between traumatic life experiences, mental health, and drug use in a sample of African American women. It was hypothesized that there would be an inverse relationship overall between spirituality and mental health and drug use among this sample of African American women. Secondly, was expected that spirituality would moderate the relationship between traumatic life events and mental health and drug use. African American women (n = 206) were recruited from the community and from probation officers in three urban areas of a southern state, and face-to-face interviews were completed. Findings indicated that there was a main effect for spirituality (as measured by existential well-being on the Spiritual Well-Being Scale) and traumatic life events, mental health, and alcohol use. In addition, spirituality was a significant moderator of the relationship between traumatic life events and cocaine use. Discussion and implications for African American women are included.
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Affiliation(s)
- Michele Staton-Tindall
- 1UK College of Social Work, Center on Drug and Alcohol Research, University of Kentucky , Lexington, Kentucky , USA
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40
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Oser CB, Biebel EP, Havens JR, Staton-Tindall M, Knudsen HK, Mooney JL, Leukefeld CG. Inmate Pre-Release Assessment (IPASS) Aftercare Placement Recommendation as a Predictor of Rural Inmate's 12-Step Attendance and Treatment Entry Post-Release. JOURNAL OF OFFENDER REHABILITATION 2009; 48:725-743. [PMID: 20419069 PMCID: PMC2856953 DOI: 10.1080/10509670903287899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The purpose of this study is to use the Criminal Justice Drug Abuse Treatment Studies' (CJ-DATS) Inmate Pre-Release Assessment (IPASS), which recommends either intensive or non-intensive treatment after release, to predict rural offenders'12-step attendance and treatment entry within 6 months of release from prison. IPASS scores indicated that 52% of rural offenders needed intensive treatment upon community re-entry. In bivariate analyses, rural offenders with an intensive aftercare placement recommendation were significantly younger, more likely to have been employed more months in the year prior to incarceration, to have ever injected drugs, and to have ever received outpatient substance abuse treatment. The variables which were significant at the bivariate level were entered into two logistic multivariate models predicting 12-step attendance and treatment entry within 6 months of being released from prison. Age and having ever injected drugs were positive predictors of having attended a 12-step meeting, while the number of months legally employed was negatively related to 12-step attendance. In the treatment entry model, age increased the odds of entering formal treatment while having ever injected a drug decreased the odds. IPASS aftercare placement recommendation was not significant in either of the multivariate models. Findings from this study suggest that offenders re-entering rural communities may receive limited community-based continued care and future studies should explore geographic-specific treatment barriers. Implications for rural substance abuse treatment are provided.
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Affiliation(s)
- Carrie B. Oser
- University of Kentucky, Department of Sociology, Center on Drug & Alcohol Research
| | - Elizabeth P. Biebel
- University of Kentucky, Department of Sociology, Center on Drug & Alcohol Research
| | - Jennifer R. Havens
- University of Kentucky, Department of Behavioral Science, Center on Drug & Alcohol Research
| | | | - Hannah K. Knudsen
- University of Kentucky, Department of Behavioral Science, Center on Drug & Alcohol Research
| | - Jenny L. Mooney
- University of Kentucky, Department of Sociology, Center on Drug & Alcohol Research
| | - Carl G. Leukefeld
- University of Kentucky, Department of Behavioral Science, Center on Drug & Alcohol Research
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