There has been an alarmingly rise in the number of overdose deaths, HIV, and HCV infections attributed to the misuse of prescription opioids in the United States. At the same time, there has been greater awareness about how community context affects health outcomes. For many years, opioid use was endemic to low- income urban areas but more recently has become problematic outside of urban centers. This geographic shift has led to a greater focus on opioid misuse in rural settings. However, the U.S. is a suburban nation with the majority of Americans living in suburbs. By focusing on urban versus rural epidemics, our current knowledge fails to address the growing opioid crisis in understudied semi-rural and suburban settings. The overarching goal of this study is to determine how community-level conditions shape awareness and utilization of services that reduce the harms associated with opioid misuse in semi-rural and suburban communities. We will accomplish this by integrating a novel geospatial method with the Comprehensive Model of Information Seeking (CMIS) to understand the community context of opioid misuse, including the extent to which community conditions affect how individuals seek out information related to their opioid misuse. We propose to develop community typologies of semi-rural and suburban areas, by sorting communities into cohesive groups according to shared placed-based features and determining how these typologies associate with individual-level drug use outcomes (Aim 1). We will also identify the characteristics of the health information sources (e.g., drug using peers, internet, community programs, clinicians) used by prescription opioid misusers and determine their association with community typologies (Aim 2). Our study aims will be accomplished by interviewing a cross-sectional sample of n=270 individuals misusing prescription opioids in San Diego County, California; a county largely comprised of semi-rural and suburban communities, with limited services, above average statewide rates of accidental opioid-related overdose death, and above average statewide rates of opioid prescribing. Overall, we expect to gain more clarity about conditions in semi-rural and suburban settings that collectively shape prescription opioid misuse and that affect how individuals obtain information about and access prevention and treatment services. Findings will guide the development of a larger spatially-informed study of where and how to target treatment and prevention services, while also offering a generalizable approach to extending geospatial approaches with the CMIS framework to other underserved regions.

Public Health Relevance

Prescription drug abuse patterns are often considered in isolation with limited consideration about the effects that place-based characteristics have on individual-level drug use outcomes and health information uptake. This study will expand our understanding of the broader contextual factors underlying prescription drug abuse in geographically dispersed settings (i.e., semi-rural and suburban communities) by combining an innovative geographical information system (GIS) approach with the Comprehensive Model of Information Seeking framework to determine how suburban and semi-rural prescription opioid misusers seek information about their drug use and how they access prevention and treatment resources in their community. Findings will provide guidance to public health officials, support groups and policy makers on identifying at-risk environments in order to target prevention and treatment resources more effectively.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Exploratory/Developmental Grants (R21)
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Community Influences on Health Behavior Study Section (CIHB)
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Hartsock, Peter
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University of California, San Diego
Internal Medicine/Medicine
Schools of Medicine
La Jolla
United States
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