The rates of non-medical prescription drug use in the United States (U.S.) have increased dramatically in the last two decades, leading to a more than 300% increase in deaths from overdose, surpassing motor vehicle accidents as the leading cause of injury deaths. In rural areas, deaths from unintentional overdose have increased by more than 250% since 1999 while urban deaths have increased at a fraction of this rate. The objective of this research was to test the hypothesis that cultural, economic, and environmental factors prevalent in rural America affect the rate of substance use disorder (SUD) in that population, and that diagnosis of these disorders across rural and urban populations may not be generalizable due to these same effects. This study applies measurement invariance analysis and factor analysis techniques: item response theory (IRT), multiple indicators, multiple causes (MIMIC), and latent class analysis (LCA), to the DSM-IV abuse and dependency diagnosis instrument. The sample used for the study was a population of adult past-year illicit drug users living in a rural or urban area drawn from the 2011-2012 National Survey on Drug Use and Health data files (N = 3,369| analyses 1 and 2; N = 12,140| analysis 3). Results of the IRT and MIMIC analyses indicated no significant variance in DSM item function across rural and urban sub-groups; however, several socio-demographic variables including age, race, income, and gender were associated with bias in the instrument. Latent class structures differed across the sub-groups in quality and number, with the rural sample fitting a 3-class structure and the urban fitting 6-class model. Overall the rural class structure exhibited less diversity and lower prevalence of SUD in multiple drug categories (e.g. cocaine, hallucinogens, and stimulants). This result suggests underlying elements affecting SUD patterns in the two populations. These findings inform the development of surveillance instruments, clinical services, and public health programming tailored to specific communities.

Background: University scholars and community members formed the Prescription Drug Abuse and Misuse Working Group in response to the prescription drug abuse/misuse epidemic plaguing the Appalachian region. Their collaboration has yielded no fewer than four funded and six volunteer service projects in the community. A concern voiced by key community stakeholders has been the non-medical use of prescription drugs (NMUPD) among the workforce. The team discovered that the relationship between NMUPD and workplace characteristics is understudied. This study aimed to show the overall and industry-specific prevalence of NMUPD, and to examine workplace characteristics associated with NMUPD. Methods: Data from the 2011-2012 National Survey on Drug Use and Health (NSDUH) were used. Multiple logistic regression assessed workplace characteristics on past-year NMUPD among employed adults 18 years and older, controlling for demographic variables. Results: The overall prevalence of NMUPD was 9.23% (95% CI: 8.98-9.48). The industries with the highest prevalence were: arts, entertainment, recreation, accommodation, and food services (14.48%; 95% CI: 13.70-15.27), construction (10.82%; 95% CI: 9.77-11.87), and retail trade (10.04%; 95% CI: 9.34-10.74). NMUPD was significantly associated with industry type (p Conclusions: Results suggest alcohol or drug use workplace policies and employee assistance or other counseling programs may protect against NMUPD. Workplace prevention efforts for NMUPD could benefit from incorporating these approaches.

Background: Prescription drug abuse is a major public health concern in the United States, associated with dramatic increases in morbidity and mortality over the past two decades. In recent years, disposal of unwanted, unused, and expired medications has been a pillar of national prevention efforts. Acknowledging increased policy and advocacy emphasis on improving prescription drug disposal behaviors of consumers, the purpose of this study was to evaluate the impacts of a targeted promotional campaign on participation in community-based drug take back events (TBE) in NE Tennessee. Methods: Between October 2013 and October 2017, 45 drug take-back events were held in 5 municipalities across NE Tennessee. A region-wide, promotional campaign including direct to consumer advertising (television, print, radio, etc) initiated spring 2014. Two methods of data collection were implemented: 1) donor surveys; and 2) drug donation weights (pounds) and dosage units collected. Controlled substance (CS) donations with identifiable dispensing dates were used to calculate donors’ possession time in months. One-way ANOVA, paired t-tests, and chi-square procedures were utilized to assess trends in donation weights, time to donation, and donor characteristics across the study period. Results: Total Disposal donations increased by 2.35 times (CS 2.61 times) from baseline after the initial promotional campaign. A total of 2300 CS donations were collected, with a spike in total pounds collected observed in spring of 2014 following initial marketing interventions. Donor possession time hdecreased by approximately one year during the length of the study (62.01 to 50.5 months). More than 1500 donor surveys were administered during the study. Half of all participants reported hearing about TBE through television promotions. Participants at urban events were 52.6% more likely than rural participants to hear about the event through newspaper promotion. Conclusion: Collaborative marketing across a TBE concentrated region increases CS disposal weight and decreases donor possession time.