Examining Rural/Urban Differences in Prescription Opioid Misuse Among US Adolescents

• Published in: The Journal of rural health Vol. 32; no. 2; pp. 204 - 218
• Main Authors: Monnat, Shannon M., Rigg, Khary K.
• Format: Journal Article
• Language: English
• Published: England Journal of Rural Health 01.03.2016; Blackwell Publishing Ltd; Wiley Subscription Services, Inc
• Subjects: Addictions; Adolescent; Adolescents; Child; Communities; Courts; Crime; Data analysis; demography; Drug abuse; Drug addiction; Drug courts; Drug use; Early intervention; Emergency medical services; Emergency services; epidemiology; Family law; Female; geography; Health care policy; Health disparities; Health services; Humans; Intervention; Logistic Models; Male; Mediation; Medical treatment; Offenders; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - psychology; Opioids; Parent-Child Relations; Peer Group; Policy making; Prescribing; Prescription Drugs; Protective factors; Regression analysis; Reliance; Religion; Religious beliefs; Residence Characteristics - statistics & numerical data; Residents; Risk; Risk analysis; Risk Assessment; Risk Factors; Risk perception; Rural areas; Rural communities; Rural education; Rural Population - statistics & numerical data; Rural populations; Rural urban differences; Socioeconomic Factors; sociology; Substance abuse; Substance abuse treatment; Substance use; Substance-Related Disorders - epidemiology; Substance-Related Disorders - psychology; Teenagers; Treatment programs; United States; Urban areas; Urban Population - statistics & numerical data; United States; United States > US; USA; epidemiology; drug abuse; demography; geography; sociology
• ISSN: 0890-765X; 1748-0361
• DOI: 10.1111/jrh.12141

PURPOSE: This study examines differences in prescription opioid misuse (POM) among adolescents in rural, small urban, and large urban areas of the United States and identifies several individual, social, and community risk factors contributing to those differences. METHODS: We used nationally representative data from the 2011 and 2012 National Survey on Drug Use and Health and estimated binary logistic regression and formal mediation models to assess past‐year POM among 32,036 adolescents aged 12‐17. RESULTS: Among adolescents, 6.8% of rural, 6.0% of small urban, and 5.3% of large urban engaged in past‐year POM. Net of multiple risk and protective factors, rural adolescents have 35% greater odds and small urban adolescents have 21% greater odds of past‐year POM compared to large urban adolescents. The difference between rural and small urban adolescents was not significant. Criminal activity, lower perceived substance use risk, and greater use of emergency medical treatment partially contribute to higher odds among rural adolescents, but they are also partially buffered by less peer substance use, less illicit drug access, and stronger religious beliefs. CONCLUSIONS: Researchers, policy makers, and treatment providers must consider the complex array of individual, social, and community risk and protective factors to understand rural/urban differences in adolescent POM. Potential points of intervention to prevent POM in general and reduce rural disparities include early education about addiction risks, use of family drug courts to link criminal offenders to treatment, and access to nonemergency medical services to reduce rural residents’ reliance on emergency departments where opioid prescribing is more likely.