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Borders TF, Hammerslag L. Discussions of Cancer Survivorship Care Needs: Are There Rural Versus Urban Inequities? Med Care 2024; 62:473-480. [PMID: 38775667 PMCID: PMC11155275 DOI: 10.1097/mlr.0000000000002014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Rural cancer survivors may face greater challenges receiving survivorship care than urban cancer survivors. PURPOSE To test for rural versus urban inequities and identify other correlates of discussions about cancer survivorship care with healthcare professionals. METHODS Data are from the 2017 Medical Expenditure Panel Survey (MEPS), which included a cancer survivorship supplement. Adult survivors were asked if they discussed with a healthcare professional 5 components of survivorship care: need for follow-up services, lifestyle/health recommendations, emotional/social needs, long-term side effects, and a summary of treatments received. The Behavioral Model of Health Services guided the inclusion of predisposing, enabling, and need factors in ordered logit regression models of each survivorship care variable. RESULTS A significantly lower proportion of rural than urban survivors (42% rural, 52% urban) discussed in detail the treatments they received, but this difference did not persist in the multivariable model. Although 69% of rural and 70% of urban ssurvivors discussed in detail their follow-up care needs, less than 50% of both rural and urban survivors discussed in detail other dimensions of survivorship care. Non-Hispanic Black race/ethnicity and time since treatment were associated with lower odds of discussing 3 or more dimensions of survivorship care. CONCLUSIONS This study found only a single rural/urban difference in discussions about survivorship care. With the exception of discussions about the need for follow-up care, rates of discussing in detail other dimensions of survivorship care were low among rural and urban survivors alike.
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Affiliation(s)
| | - Lindsey Hammerslag
- Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY
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Wandji SR, Tavakoli AS, Davis JE, Pope R, Abshire DA. Racial and gender differences in relapse potential and treatment acceptance among rural residents in a substance use disorder treatment program. J Rural Health 2024. [PMID: 38825752 DOI: 10.1111/jrh.12849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 04/02/2024] [Accepted: 05/17/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE To examine racial and gender differences in treatment acceptance and relapse potential among rural residents admitted to a substance use disorder (SUD) treatment program. METHODS A cross-sectional study using data collected from a sample of 1850 rural residents admitted to a South Carolina state-run SUD treatment center between the years of 2018 and 2020. Chi-square and t-tests were used to compare treatment acceptance and relapse potential by race and gender. Multivariate logistic regression analyses was conducted to further examine the relationship of race and gender with treatment acceptance and relapse potential after adjusting for potential confounding variables. FINDINGS Approximately 50% of participants were classified as being accepting of their treatment and committed to changing their substance use, and there were no racial or gender differences in the bivariate and multivariate analyses. Approximately 25% of participants were classified as having low/no potential risk for relapsing, and there were no racial or gender differences in the bivariate analysis. However, the adjusted odds ratio of relapsing risk were lower among White compared to Black adults [AOR = 0.49 with 95% CI (0.31-0.77)]. CONCLUSION This study suggests there are no gender or racial differences in treatment acceptance for SUD but that Black adults are at greater risk of relapsing relative to White adults. Additional research is needed to identify factors that increase Black adults' risk for relapse to inform interventions that can improve SUD treatment outcomes in this population.
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Affiliation(s)
- Serge R Wandji
- Yale University School of Public Health New Haven, New Haven, Connecticut, USA
| | - Abbas S Tavakoli
- University of South Carolina College of Nursing, Columbia, South Carolina, USA
| | - Jean E Davis
- University of South Carolina College of Nursing, Columbia, South Carolina, USA
| | - Robert Pope
- Dominican University of California, San Rafael, California, USA
| | - Demetrius A Abshire
- University of South Carolina College of Nursing, Columbia, South Carolina, USA
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Wandji SR, Abshire DA, Davis JE, Tavakoli AS, Pope R. Substance use disorders among African-American men in the rural south: A scoping review. J Ethn Subst Abuse 2023:1-23. [PMID: 37655703 DOI: 10.1080/15332640.2023.2248029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
African American (AA) men in the rural South may be at high risk for experiencing adverse health outcomes from substance use (SU). We conducted a scoping review to explore the research on SU among rural AA men in the rural South of the United States (US). Ten articles addressed the following thematic areas pertaining to SU: factors associated with SU (n = 6), associations between substance use and health outcomes (n = 2), and the influence of impulsivity on SU (n = 2). Additional research on SU among AA men in the rural South is needed, particularly pertaining to treatment-related considerations.
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Affiliation(s)
| | | | - Jean E Davis
- University of South Carolina, Columbia, South Carolina
| | | | - Robert Pope
- Dominican University of California, San Rafael, California
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4
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Walters SM, Felsher M, Frank D, Jaiswal J, Townsend T, Muncan B, Bennett AS, Friedman SR, Jenkins W, Pho MT, Fletcher S, Ompad DC. I Don't Believe a Person Has to Die When Trying to Get High: Overdose Prevention and Response Strategies in Rural Illinois. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1648. [PMID: 36674402 PMCID: PMC9864395 DOI: 10.3390/ijerph20021648] [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: 11/16/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Overdose is a leading cause of morbidity and mortality among people who inject drugs. Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths. METHODS Semi-structured interviews were conducted with 23 participants (19 persons who inject drugs and 4 service providers) from rural southern Illinois. Data were analyzed using constant comparison and theoretical sampling methods. RESULTS Participants were concerned about the growing presence of fentanyl in both opioids and stimulants, and many disclosed overdose experiences. Strategies participants reported using to lower overdose risk included purchasing drugs from trusted sellers and modifying drug use practices by partially injecting and/or changing the route of transmission. Approximately half of persons who inject drugs sampled had heard of fentanyl test strips, however fentanyl test strip use was low. To reverse overdoses, participants reported using cold water baths. Use of naloxone to reverse overdose was low. Barriers to naloxone access and use included fear of arrest and opioid withdrawal. CONCLUSIONS People who inject drugs understood fentanyl to be a potential contaminant in their drug supply and actively engaged in harm reduction techniques to try to prevent overdose. Interventions to increase harm reduction education and information about and access to fentanyl test strips and naloxone would be beneficial.
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Affiliation(s)
- Suzan M. Walters
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
| | - Marisa Felsher
- College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - David Frank
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Jessica Jaiswal
- Department of Health Science, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Tarlise Townsend
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Brandon Muncan
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Alex S. Bennett
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Samuel R. Friedman
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Wiley Jenkins
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL 62702, USA
| | - Mai T. Pho
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | | | - Danielle C. Ompad
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
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5
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Causey ST, Towe SL, Hartsock J, Xu Y, Meade CS. Perceived Healthcare Access among Persons with and without HIV Who Use Illicit Stimulants: The Role of Cumulative Risk. Subst Use Misuse 2021; 56:1387-1396. [PMID: 34034631 PMCID: PMC8370044 DOI: 10.1080/10826084.2021.1928211] [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] [Indexed: 10/21/2022]
Abstract
Background: Persons who use stimulant drugs have greater morbidity and mortality relative to non-users. HIV infection has the potential to contribute to even great disparity in health outcomes among persons who use stimulants. These health disparities likely result in part due to poorer access to healthcare. Our study used a cumulative risk model to examine the impact of multiple risk factors on healthcare access in a sample of persons with and without HIV who use stimulants. Method: Our sample included 453 persons who reported recent use of illicit stimulants (102 HIV+, 351 HIV-). Participants completed clinical interviews, questionnaires, and a rapid oral HIV test. We constructed an 8-item cumulative risk index that included factors related to socioeconomic status, homelessness, legal history, and substance use. Results: Participants with HIV (PHW) were older than participants without HIV and more likely to have health insurance. Participants with and without HIV reported similar prior treatment utilization, but PWH reported better healthcare access and lower cumulative risk scores. Regression analyses showed cumulative risk was a significant predictor of healthcare access (β = -0.20, p < 0.001) even after controlling for age, HIV status, and health insurance status. We did not observe an interaction of HIV status by cumulative risk. Conclusions: Access to care among persons who use stimulants, both with and without HIV, is negatively impacted by the accumulation of risk factors from a number of different domains. Understanding the cumulative effects of these factors is critical for developing interventions to facilitate access to care, thus reducing health disparities and improving health outcomes.
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Affiliation(s)
- Shakiera T Causey
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sheri L Towe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jeremiah Hartsock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Yunan Xu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Dogan J, Stevens-Watkins D, Knighton JS, Wheeler P, Hargons C. Perceived need for drug treatment among African American male drug-using prisoners. J Subst Abuse Treat 2021; 120:108166. [PMID: 33298302 PMCID: PMC7733029 DOI: 10.1016/j.jsat.2020.108166] [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: 02/17/2020] [Revised: 06/30/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
Since 2016, African Americans have experienced the largest increase in cocaine-related drug overdose deaths compared to other racial/ethnic groups. African American male prisoners who used drugs prior to incarceration are at an increased risk for relapse and overdose upon community re-entry. Using the Theory of Planned Behavior as a guiding framework, this study examined correlates of perceived need for treatment among 193 drug-using incarcerated African American men nearing release. Linear regression analyses revealed that the number of lifetime drug overdoses, severity of legal problems, and previous drug treatment significantly predicted a need for treatment. Further, more frequent drug use, specifically crack cocaine, in the month prior to incarceration predicted a higher perceived need for drug treatment. Implications suggest this population demonstrates a need for treatment, which may be exacerbated by re-entry stressors. Preventative measures, including culturally tailored treatment and transitional care from prison to community-based services, are necessary to reduce risk of relapse and overdose among this group.
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Affiliation(s)
- Jardin Dogan
- University of Kentucky, Department of Educational, School, and Counseling Psychology, , 36 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
| | - Danelle Stevens-Watkins
- University of Kentucky, Department of Educational, School, and Counseling Psychology, 235 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
| | - Joi-Sheree Knighton
- Center for Forensic Psychiatry, Michigan Department of Health and Human Services (MDHHS), P.O. Box 2060, Ann Arbor, MI 48160, United States of America.
| | - Paris Wheeler
- University of Kentucky, Department of Educational, School, and Counseling Psychology, 235 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
| | - Candice Hargons
- University of Kentucky, Department of Educational, School, and Counseling Psychology, 239 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
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7
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Smith KE, Archuleta A, Staton M, Winston E. Risk factors for heroin use following release from jail or prison in adults in a Central Appalachian state between 2012-2017. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:485-497. [PMID: 33223579 PMCID: PMC7678949 DOI: 10.1080/00952990.2020.1725032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 02/05/2023]
Abstract
Background Corrections-involved adults with a history of opioid use disorder are at elevated risk of opioid overdose following release from correctional settings. Increased opioid prescribing restrictions and monitoring during a time when heroin is becoming cheaper and ubiquitous means that adults who misused prescription opioids prior to incarceration may be reentering communities at greater risk for heroin exposure and use. Objectives Determine risk factors of post-release heroin use among a sample of adults who participated in corrections-based drug treatment in Kentucky released between 2012 and 2017. Methods Survey data obtained as part of an ongoing evaluation of corrections-based drug treatment were examined. Results The final sample (N = 1,563) was majority male (80.9%). Nearly 11.0% reported past-year heroin use following their release. Depressive symptoms, polydrug use, and urban proximity were more common among participants reporting post-release heroin use. Heroin use 30 days prior to incarceration was associated with a 432.1% increase in odds of heroin use subsequent to incarceration. Post-release suicidal ideation increased odds of heroin use by 154.2%, whereas reporting satisfaction from social interactions decreased odds of use by nearly 60%. Post-release use of cocaine and diverted buprenorphine were associated with increased likelihood of heroin use during this time period, increasing odds by 469.1% and 265.9%, respectively. Residing in Central Appalachia subsequent to incarceration was associated with decreased likelihood of use. Conclusions In this sample, post-release heroin use was associated with concerning features, such as polydrug use, lack of social satisfaction, and suicidal ideation. These features can serve as clear targets for clinical intervention.
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Affiliation(s)
- Kirsten Elin Smith
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, KY, USA
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Adrian Archuleta
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Michele Staton
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, KY, USA
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Erin Winston
- Center on Drug and Alcohol and Research, University of Kentucky, Lexington, KY, USA
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8
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Moeller SJ, Platt JM, Wu M, Goodwin RD. Perception of treatment need among adults with substance use disorders: Longitudinal data from a representative sample of adults in the United States. Drug Alcohol Depend 2020; 209:107895. [PMID: 32078975 PMCID: PMC7418940 DOI: 10.1016/j.drugalcdep.2020.107895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Most individuals with substance use disorders (SUDs) do not seek treatment. Lack of perceived treatment need (PTN) is one contributing factor, but little is known about PTN over time. We estimated whether PTN changed over three years among those with SUDs in the United States and identified select variables, including sociodemographics and symptom burden, that predict malleability vs. stability of PTN. METHODS Data were from Waves 1 (collected 2001-2002) and 2 (collected 2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC); 1695 adults who met DSM criteria for alcohol or non-alcohol SUD at Wave 1 and maintained ≥1 diagnostic symptom at Wave 2 were included. RESULTS Most individuals with SUDs (77.2%) did not perceive a need for treatment at Wave 1 baseline. Only about 1 in 8 individuals not perceiving a need for treatment in Wave 1 came to perceive a need in Wave 2 (adjusted odds ratio = 0.18, 99% confidence interval = 0.11-0.29). In contrast, about half the individuals who perceived a need for treatment in Wave 1 no longer did so in Wave 2, despite maintaining ≥1 SUD symptom. Married respondents, and respondents with more SUD symptoms, were more likely to transition from low- to high-PTN status three years later. Respondents with incomes >$35,000 were less likely to transition to high-PTN status three years later. CONCLUSIONS PTN was more likely to decline than increase over time. Low PTN appears to be stable among adults with SUDs in the United States, presenting a potentially enduring barrier to treatment-seeking.
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Affiliation(s)
- Scott J. Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Jonathan M. Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Melody Wu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Renee D. Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA
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Arsyad M, Pulubuhu DAT, Kawamura Y, Maria IL, Dirpan A, Unde AA, Nuddin A, Yusuf S. The role of public health services (PHS) in agricultural poverty alleviation. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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10
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Russell C, Neufeld M, Sabioni P, Varatharajan T, Ali F, Miles S, Henderson J, Fischer B, Rehm J. Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in Northern Ontario, Canada. PLoS One 2019; 14:e0225548. [PMID: 31805082 PMCID: PMC6894813 DOI: 10.1371/journal.pone.0225548] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/06/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Illicit drug use rates are high among Canadian youth, and are particularly pronounced in Northern Ontario. The availability and accessibility of effective substance use-related treatments and services are required to address this problem, especially among rural and remote Northern communities. In order to assess specific service and treatment needs, as well as barriers and deterrents to accessing and utilizing services and treatments for youth who use illicit drugs in Northern Ontario, we conducted the present study. METHODS This study utilized a mixed-methods design and incorporated a community-based participatory research approach. Questionnaires were administered in conjunction with audio-recorded semi-structured interviews and/or focus groups with youth (aged 14-25) who live in Northern Ontario and use illicit drugs. Interviews with 'key informants' who work with the youth in each community were also conducted. Between August and December 2017, the research team traveled to Northern Ontario communities and carried out data collection procedures. RESULTS A total of 102 youth and 35 key informants from eleven different Northern Ontario communities were interviewed. The most commonly used drugs were prescription opioids, cocaine and crack-cocaine. Most participants experienced problems related to their drug use, and reported 'fair' mental and physical health status. Qualitative analyses highlighted an overall lack of services; barriers to accessing treatment and services included lack of motivation, stigmatization, long wait-lists and transportation/mobility issues. Articulated needs revolved around the necessity of harm reduction-based services, low-threshold programs, specialized programming, and peer-based counselling. CONCLUSIONS Although each community varied in terms of drug use behaviors and available services, an overall need for youth-specific, low-threshold services was identified. Information gathered from this study can be used to help inform rural and remote communities towards improving treatment and service system performance and provision.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Maria Neufeld
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
| | - Pamela Sabioni
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Translational Addiction Research Lab, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Thepikaa Varatharajan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Sarah Miles
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Joanna Henderson
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benedikt Fischer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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11
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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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Woodhead EL, Timko C, Han X, Cucciare MA. Stigma, Treatment, and Health among Stimulant Users: Life Stage as a Moderator. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2019; 60:96-104. [PMID: 31548756 PMCID: PMC6756791 DOI: 10.1016/j.appdev.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This 3-year study examined associations among drug use stigma, life stage, treatment utilization and health among 710 US adults using stimulants. Consistent with substance use developmental frameworks, life stage was represented by Emerging adulthood (18-25 years old, n=223), Earlymid adulthood (26-44 years old; n=384), and Older adulthood (45-61 years old; n=103). Emerging adults experienced less enacted stigma (i.e., experiences of discrimination) and perceived less public stigma (i.e., unjust treatment) over the course of the study than other life stage groups. More baseline enacted stigma was associated with more mental health and substance use treatment, whereas more baseline self stigma (i.e., negative thoughts about the self) was associated with less treatment utilization. Life stage moderated stigma-outcome associations such that substance use outcomes were worse for Emerging adults reporting more enacted stigma. Although emerging adults experienced less drug use stigma, stigma had a more negative impact on adults in this life stage.
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Affiliation(s)
- Erin L Woodhead
- Department of Psychology, San José State University, 1 Washington Square, San José, CA, 95192-0120, ,
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, 795 Willow Rd, Menlo Park, CA 94025 USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304 USA
| | - Xiaotong Han
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205 USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 92205 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205 USA
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205 USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 92205 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205 USA
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Cucciare MA, Scarbrough CB. Opportunities for Identifying and Addressing Unhealthy Substance Use in Rural Communities: A Commentary on Cucciare et al (2017). SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2018; 12:1178221818805980. [PMID: 30349283 PMCID: PMC6195001 DOI: 10.1177/1178221818805980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 11/26/2022]
Abstract
Unhealthy substance use is a public health problem facing rural communities across the United States. Unfortunately, numerous challenges including stigma, perceived need for care, and perceived accessibility of substance use treatment serve as barriers to many rural adults using substances in obtaining the care they need. It is therefore important to examine whether accessing health care options other than substance use treatment is associated with improved substance use. In a recent study published in the American Journal of Drug and Alcohol Abuse, we explored whether use of outpatient medical care (OMC) was associated with reductions in substance use among rural stimulant users over a 3-year period. Overall, the results showed that, among rural adults using stimulants, those with at least one OMC visit had fewer days of alcohol, crack cocaine, and methamphetamine use over time. However, most participants reported not having any use of an OMC over the 3-year period, suggesting the need for identifying innovative opportunities to provide substance use help for persons living in rural settings. In this commentary, we discuss opportunities for detecting and addressing unhealthy substance use in retail clinics, via clergy and pharmacists.
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Affiliation(s)
- Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA.,VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA
| | - Catherine B Scarbrough
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Cucciare MA, Kennedy KM, Han X, Timko C, Zaller N, Booth BM. Utilization of outpatient medical care and substance use among rural stimulant users: Do the number of visits matter? J Subst Abuse Treat 2018; 86:78-85. [PMID: 29415855 DOI: 10.1016/j.jsat.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/27/2017] [Accepted: 01/03/2018] [Indexed: 01/16/2023]
Abstract
Rural substance users are less likely than their urban peers to use formal substance use treatment. It is therefore important to understand how the utilization of potentially more appealing care options, such as outpatient medical care (OMC), may affect substance use over time. This study sought to examine whether the number of OMC visits, after controlling for important covariates, was associated with days of alcohol, crack and powder cocaine, and methamphetamine use among a sample of rural stimulant users over a three year period. Data were collected from a natural history study of 710 stimulant users living in rural communities in Arkansas, Kentucky, and Ohio. Participants were adults, not in drug treatment, and reporting stimulant use in the last 30days. In terms of alcohol use, for participants with higher employment-related problems, having 3 or more OMC visits (relative to none) was associated with fewer days of alcohol use. The results for days of cocaine and methamphetamine use were mixed. However, we did find that for participants reporting at least one substance use treatment or mutual help care visit in the past 6-months, having 1-2 OMC visits (compared to none) was associated with fewer days of crack cocaine use. Regarding methamphetamine use, results showed that for participants without medical insurance, having 3 or more OMC visits (compared to none) was associated with significantly fewer days of methamphetamine use if they also reported greater than or equal to a high school education. The findings from this study may help us begin to understand some of the characteristics of rural drug users, who utilize OMCs, associated with reductions in substance use. These findings may help health care administrators better plan, coordinate, and allocate resources to rural OMCs to more effectively address substance use in this population.
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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.
| | - 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
| | - Xiaotong Han
- 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
| | - 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
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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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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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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Cucciare MA, Han X, Timko C, Zaller N, Kennedy KM, Booth BM. Longitudinal associations between outpatient medical care use and substance use among rural stimulant users. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:235-243. [PMID: 28662352 DOI: 10.1080/00952990.2017.1339056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Negative views toward substance use treatment among some rural substance users and limited treatment resources in rural areas likely affect substance use utilization. It is therefore important to determine whether accessing healthcare options other than substance use treatment, specifically outpatient medical care (OMC), is associated with reductions in substance use. OBJECTIVES We examined whether use of OMC was associated with reductions in substance use among rural substance users over a three-year period. We also explored whether substance user characteristics, including substance-use severity and related-problems, moderated this potential relationship. METHODS Data were collected from an observational study of 710 (61% male) stimulant users using respondent-driven sampling. Participants were recruited from rural counties of Arkansas, Kentucky, and Ohio. RESULTS We found a significant main effect of having at least one OMC visit (relative to none) on fewer days of alcohol, crack cocaine, and methamphetamine use over time. Fewer days of alcohol, crack cocaine, and methamphetamine use were reported in participants with at least one OMC visit (relative to those with none) among those reporting higher Addiction Severity Index employment and psychiatric severity scores, and low education, respectively. CONCLUSION Our findings extend the results from prior studies with urban substance users to show that contact with an outpatient medical care clinic is associated with reductions in substance use over time among rural substance users with especially poorer functioning. These findings highlight the potential importance of OMCs in addressing unhealthy substance use in rural communities.
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Affiliation(s)
- Michael A Cucciare
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , AR , USA.,b Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System (CAVHS) , North Little Rock , AR , USA.,c VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS) , North Little Rock , AR , USA
| | - Xiaotong Han
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , AR , USA.,b Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System (CAVHS) , North Little Rock , AR , USA.,c VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS) , North Little Rock , AR , USA
| | - Christine Timko
- d Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System , Menlo Park , CA , USA.,e Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , CA , USA
| | - Nickolas Zaller
- f College of Public Health, Department of Health Behavior and Health Education , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Kristina M Kennedy
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , AR , USA.,g Department of Psychology and Counseling , University of Central Arkansas , Conway , AR , USA
| | - Brenda M Booth
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , AR , USA
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18
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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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19
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Keith Branham D, Borders TF, Stewart KE, Curran GM, Booth BM. Acceptability of HIV Testing Sites Among Rural and Urban African Americans Who Use Cocaine. AIDS Behav 2017; 21:576-586. [PMID: 27557985 PMCID: PMC5290213 DOI: 10.1007/s10461-016-1527-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
African Americans (AAs) who use cocaine in the Southern region of the U.S. have a relatively high risk of HIV and need for HIV testing. Among this group, those residing in rural areas may have less favorable opinions about common HIV testing sites, which could inhibit HIV testing. We examined rural/urban variations in their acceptability of multiple HIV testing sites (private physician clinic, local health department, community health center, community HIV fair, hospital emergency department, blood plasma donation center, drug abuse treatment facility, and mobile van or community outreach worker). Results from partial proportional odds and logistic regression analyses indicate that rural AA who use cocaine have lower odds of viewing local health departments (OR = 0.09, 95 % CI = 0.03-0.21), physician offices (OR = 0.19, 95 % CI = 0.09-0.42), and drug use treatment centers (OR = 0.49; 95 % CI = 0.30-0.80) as acceptable relative to their urban counterparts. The findings have implications for further targeting HIV testing toward AAs who use of cocaine, particularly those residing in the rural South.
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Affiliation(s)
- D Keith Branham
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, 40536, USA.
| | - Tyrone F Borders
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, 40536, USA
| | - Katharine E Stewart
- Department of Psychology and Provost's Office, North Carolina State University, Raleigh, NC, USA
| | - Geoffrey M Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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20
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Borders TF. Advancing the Field of Rural Health Research: Moving Beyond Simply Documenting Rural vs Urban Differences. J Rural Health 2017; 33:3-4. [DOI: 10.1111/jrh.12227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Tyrone F. Borders
- Department of Health Management and Policy; University of Kentucky; Lexington Kentucky
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21
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Zaller N, Cheney AM, Curran GM, Booth BM, Borders TF. The Criminal Justice Experience of African American Cocaine Users in Arkansas. Subst Use Misuse 2016; 51:1566-1576. [PMID: 27486889 PMCID: PMC5844222 DOI: 10.1080/10826084.2016.1188954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND African Americans are incarcerated at rates much higher than other racial and ethnic groups in the United States. OBJECTIVES We sought to qualitatively explore the relationships between ongoing involvement in the criminal justice system and continued drug use in a population of urban and rural African American cocaine users in a southern state. METHODS Semi-structured qualitative interviews were conducted among African American cocaine users in Arkansas between 2010 and 2012. Participants resided in both rural (two counties located in the eastern Arkansas Mississippi delta region) and urban (the county including the capital city of Little Rock) areas. RESULTS Numerous important themes emerged from participants' narratives, including chronic involvement with the criminal justice system (being a "career criminal"), continued access to drugs while incarcerated, relapse, and reincarceration and lack of access to effective drug treatment. Conclusion/Importance: The themes which emerged from our data speak to the collective experience that many substance using populations in the United States face in dealing with the criminal justice system. Our findings highlight the need to better, more holistic ways of engaging African American substance users in community based substance use treatment and supportive services.
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Affiliation(s)
- Nickolas Zaller
- a Department of Health Behavior and Health Education , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Ann M Cheney
- b Department of Social Medicine and Population Health , University of California Riverside School of Medicine , Riverside , California , USA
| | - Geoffrey M Curran
- c Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Brenda M Booth
- c Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Tyrone F Borders
- d Department of Health Management and Policy , University of Kentucky , Lexington , Kentucky , USA
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22
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Hyshka E, Anderson JT, Wild TC. Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs. Drug Alcohol Rev 2016; 36:295-304. [PMID: 27242102 DOI: 10.1111/dar.12427] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/24/2016] [Accepted: 03/28/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Research on perceived unmet need for care for mental health and substance use problems focuses on general populations to the detriment of hidden populations. This study describes prevalence and correlates of perceived unmet need for care in a community-based sample of street-involved people who use illicit drugs and identifies barriers to care. DESIGN AND METHODS A sample of 320 street-involved people who use drugs participated in a structured, interviewer-assisted survey in Edmonton, Canada. The survey included the Perceived Need for Care Questionnaire, which assessed unmet need for care for mental health and substance use problems across seven service types. Logistic regression examined the associations between perceived unmet need, extent of socioeconomic marginalisation and problem severity. Barriers underlying unmet service needs were also examined. RESULTS Most (82%) participants reported unmet need for one or more services during the past year. Odds of reporting one or more unmet needs were elevated amongst participants reporting substantial housing instability (adjusted odds ratio = 2.37; 95% confidence interval 1.19-4.28) and amongst participants meeting criteria for drug dependence (adjusted odds ratio = 1.22; 95% confidence interval 1.03-1.50), even after adjustment for sociodemographic covariates. Structural, rather than motivational barriers were the most commonly reported reasons underlying unmet service needs. DISCUSSION AND CONCLUSION Street-involved people who use drugs experience very high rates of perceived unmet need for care for mental health and substance use problems. General population studies on perceived unmet need are insufficient for understanding needs and barriers to care in hidden populations.[Hyshka E, Anderson JT, Wild TC. Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs. Drug Alcohol Rev 2017;36:295-304].
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Affiliation(s)
- Elaine Hyshka
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada.,Inner City Health and Wellness Program, 606-1 Community Services Centre, Royal Alexandra Hospital, Edmonton, Canada
| | - Jalene Tayler Anderson
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada.,Human Geography Program, Department of Earth and Atmospheric Sciences, 1-26 Earth Sciences Building, University of Alberta, Edmonton, Canada
| | - T Cameron Wild
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada
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23
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Mennis J, Stahler GJ. Racial and Ethnic Disparities in Outpatient Substance Use Disorder Treatment Episode Completion for Different Substances. J Subst Abuse Treat 2016; 63:25-33. [DOI: 10.1016/j.jsat.2015.12.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/30/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
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24
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Davis MM, Spurlock M, Dulacki K, Meath T, Li HFG, McCarty D, Warne D, Wright B, McConnell KJ. Disparities in Alcohol, Drug Use, and Mental Health Condition Prevalence and Access to Care in Rural, Isolated, and Reservation Areas: Findings From the South Dakota Health Survey. J Rural Health 2015; 32:287-302. [PMID: 26515583 DOI: 10.1111/jrh.12157] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Research on urban/rural disparities in alcohol, drug use, and mental health (ADM) conditions is inconsistent. This study describes ADM condition prevalence and access to care across diverse geographies in a predominantly rural state. METHODS Multimodal cross-sectional survey in South Dakota from November 2013 to October 2014, with oversampling in rural areas and American Indian reservations. Measures assessed demographic characteristics, ADM condition prevalence using clinical screenings and participant self-report, perceived need for treatment, health service usage, and barriers to obtaining care. We tested for differences among urban, rural, isolated, and reservation geographic areas, controlling for participant age and gender. FINDINGS We analyzed 7,675 surveys (48% response rate). Generally, ADM condition prevalence rates were not significantly different across geographies. However, respondents in isolated and reservation areas were significantly less likely to have access to primary care. Knowledge of treatment options was significantly lower in isolated regions and individuals in reservation areas had significantly lower odds of reporting receipt of all needed care. Across the sample there was substantial discordance between ADM clinical screenings and participant self-reported need; 98.1% of respondents who screened positive for alcohol or drug misuse and 63.8% of respondents who screened positive for a mental health condition did not perceive a need for care. CONCLUSION In a predominantly rural state, geographic disparities in ADM conditions are related to differences in access as opposed to prevalence, particularly for individuals in isolated and reservation areas. Educational interventions about ADM condition characteristics may be as important as improving access to care.
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Affiliation(s)
- Melinda M Davis
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.,Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon
| | - Margaret Spurlock
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon.,Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon
| | - Kristen Dulacki
- Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon
| | - Thomas Meath
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon
| | - Hsin-Fang Grace Li
- Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon
| | - Dennis McCarty
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon
| | - Donald Warne
- Master of Public Health Program, North Dakota State University, Fargo, North Dakota
| | - Bill Wright
- Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon
| | - K John McConnell
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon.,Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon.,Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
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25
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Borders TF, Booth BM, Curran GM. African American cocaine users' preferred treatment site: variations by rural/urban residence, stigma, and treatment effectiveness. J Subst Abuse Treat 2014; 50:26-31. [PMID: 25456092 DOI: 10.1016/j.jsat.2014.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
To encourage access, policy makers and providers need information about variations in drug users' treatment preferences. This study examined how rural/urban residence, stigma surrounding drug use, and perceived treatment availability and effectiveness are associated with African American cocaine users' preferences for the site of treatment (local, or in one's home town; nearby, or in a town nearby; and distant, or in a town farther away). Two hundred rural and 200 urban cocaine users were recruited using respondent-driven sampling and completed in-person interviews. Multinomial logit regression analyses were conducted to estimate the relative odds of preferring local vs. nearby and local vs. distant treatment. Rural cocaine users preferred distant (58%), and urban users preferred local (57%) treatment. Rural residence and a lifetime history of treatment were associated with higher odds of preferring nearby vs. local treatment; older age and greater perceived local treatment effectiveness were associated with lower odds of preferring nearby vs. local treatment. Rural residence, access to an automobile, higher rejection/discrimination stigma scores, and higher Brief Symptom Inventory-Global Severity Index scores were associated with higher odds of preferring distant vs. local treatment; older age, lower educational attainment, and greater perceived discrimination after treatment were associated with lower odds of preferring distant vs. local treatment. The findings from this study suggest that a regional approach to organizing drug use treatment services could better satisfy the preferences of rural African American cocaine users, whereas local treatment services should be expanded to meet the needs of urban cocaine users.
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Affiliation(s)
- Tyrone F Borders
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY, 40536, USA.
| | - Brenda M Booth
- Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA
| | - Geoffrey M Curran
- Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA; Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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