Rural/Urban Residence, Access, and Perceived Need for Treatment Among African American Cocaine Users. Issue 1 (11th September 2014)

• Record Type: Journal Article
• Authors: Borders, Tyrone F.; Booth, Brenda M.; Stewart, Katharine E.; Cheney, Ann M.; Curran, Geoffrey M.
• Is Part Of: Journal of rural health. Volume 31:Issue 1(2015:Winter)
• Page Start: 98
• Page End: 107
• Publication Date: 2014-09-11
• Subjects: Rural health -- Periodicals; Rural health -- United States -- Periodicals; Medicine, Rural -- Periodicals; Medicine, Rural -- United States -- Periodicals; 362.104257
• DOI: 10.1111/jrh.12092
• Languages: English
• ISSNs: 0890-765X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="jrh12092-sec-0010" sec-type="section"> <title>Objective</title> <p>To examine how rural/urban residence, perceived access, and other factors impede or facilitate perceived need for drug use treatment, a concept closely linked to treatment utilization.</p> </sec> <sec id="jrh12092-sec-0020" sec-type="section"> <title>Study Design</title> <p>Two hundred rural and 200 urban African American cocaine users who were not receiving treatment were recruited via Respondent‐Driven Sampling and completed a structured in‐person interview. Bivariate and multivariate analyses were conducted to test the associations between perceived need and rural/urban residence, perceived access, and other predisposing (eg, demographics), enabling (eg, insurance), and health factors (eg, psychiatric distress).</p> </sec> <sec id="jrh12092-sec-0030" sec-type="section"> <title>Principal Findings</title> <p>In bivariate analyses, rural relative to urban cocaine users reported lower perceived treatment need (37% vs 48%), availability, affordability, overall ease of access, and effectiveness, as well as lower perceived acceptability of residential, outpatient, self‐help, and hospital‐based services. In multivariate analyses, there was a significant interaction between rural/urban residence and the acceptability of religious counseling. At the highest level of acceptability, rural users had lower odds of perceived need (OR = 0.21); at the lowest level, rural users had higher odds of perceived need (OR = 3.97) than urban users. Among rural users, the acceptability of religious counseling was negatively associated with perceived need (OR = 0.65). Ease of access was negatively associated (OR = 0.71) whereas local treatment effectiveness (OR = 1.47) and the acceptability of hospital‐based treatment (OR = 1.29) were positively associated with perceived need among all users.</p> </sec> <sec id="jrh12092-sec-0040" sec-type="section"> <title>Conclusions</title> <p>Our findings suggest rural/urban disparities in perceived need and access to drug use treatment. Among rural and urban cocaine users, improving perceptions of treatment effectiveness and expanding hospital‐based services could promote treatment seeking.</p> </sec> </abstract>