Association of perceived and internalized stigma and nonfatal opioid overdose in rural Kentucky 公开

Abstract

Drug-related stigma is theorized to be higher in rural areas, and stigma avoidance behaviors among people who use drugs may lead to an increased risk of overdose. Stigma has been associated with an increased risk of overdose in urban areas, but this relationship has not been studied in rural areas. In the context of epidemic drug overdose in rural areas, we aim to understand the association between perceived and internalized stigma and non-fatal overdose. A sample of 325 people who use drugs was recruited through respondent-driven sampling in rural counties in Kentucky. Stigma was measured with a 5-item scale measuring perceived and internalized stigma adapted from previous research. Overdose within the last 6 months was modeled with logistic regression. Of the 294 participants, 55 (16.9%) had experienced an overdose within the last six months. Both perceived stigma and internalized stigma were relatively high in the total study population, with over half (56.8%) reporting the highest level of perceived stigma and only 10.5% reporting no internalized stigma. Neither perceived nor internalized stigma was associated with overdose in the crude analysis (perceived OR=0.98 (95% CI 0.74, 1.31), internalized OR=1.36 (95% CI 0.51, 3.64)), or adjusted analysis (perceived aOR=1.13 (95% CI 0.80, 1.61), internalized aOR=1.07 (95% CI 0.31, 3.69). The null result may indicate measurement error, relatively low importance of perceived and internalized stigma in comparison to other stigma constructs, or a lack of association between stigma and overdose in the study population. Anti-stigma interventions may not be indicated for overdose prevention in rural areas, but remain important for other health outcomes.

Table of Contents

Table of Contents

Introduction .............................................................................................................................................................. 2

Methods ...................................................................................................................................................................... 4

Study Design ........................................................................................................................................................ 4

Measures ................................................................................................................................................................ 5

Analysis .................................................................................................................................................................. 6

Results ......................................................................................................................................................................... 7

Sample Characteristics.................................................................................................................................... 7

Bivariate Analysis .............................................................................................................................................. 8

Multivariable Analysis..................................................................................................................................... 8

Discussion .................................................................................................................................................................. 9

References ................................................................................................................................................................ 12

Tables .......................................................................................................................................................................... 17

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
关键词	rural stigma drug overdose opioids
Committee Chair / Thesis Advisor	Hannah Cooper, Emory University

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