Matthew Webster

PRESCRIPTION DRUG USE, HEALTH SERVICES UTILIZATION, AND HEALTH PROBLEMS IN RURAL APPALACHIAN KENTUCKY

Rural states like Kentucky now lead the nation in the illicit diversion of narcotic prescription drugs. In order to understand this phenomenon, we examine the currently popularly abused prescription drug OxyContin® by comparing differences in drug use, health services use, and criminality among a nontreatment group of rural Appalachian probationers who reported using OxyContin® (n = 101) with nonusers of OxyContin® (n = 194). Although OxyContin® users were younger, a number of differences emerged. OxyContin® users exhibited higher levels of use for 15 illicit drugs examined; used more detoxification services; attended more AA/NA meetings; reported more depression, anxiety, trouble concentrating, and violence; and reported more crime for 16 crimes. We discuss the implications of OxyContin® use including the possibility that it may be a marker for other illicit rural drug use.

HIV Prevention Among High-Risk and Hard-to-Reach Rural Residents

Abstract HIV infection and HIV risk behaviors are primarily considered to be urban problems. However, rural areas are also experiencing HIV. Because the criminal justice system has a disproportionate number of persons at high risk for HIV, rural probationers were targeted. This article (1) describes an intervention designed to change the high-risk drug use and sexual behaviors of rural residents on probation; and (2) presents information on 200 rural probationers who entered a project to reduce drug use and risky sex. After informed consent was obtained, participants were randomly assigned to either the NIDA standard HIV intervention or a “rural-focused” HIV intervention that incorporates the NIDA intervention as well as thought mapping and structured stories. The rural focused intervention is grounded in the Stages of Change theory and motivational interviewing. Initial findings indicate that participants reported high levels of lifetime illicit drug use and risky sexual behaviors. Participants also reported limited knowledge about protection from HIV and hepatitis. These findings suggest that the project is reaching a group of rural residents who engage in high-risk drug and sexual behaviors.

Correlates of Injection Drug Use Among Rural Appalachian Women

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.