Rural/Urban Residence, Access, and Perceived Need for Treatment Among African American Cocaine Users
Rural/Urban Residence, Access, and Perceived Need for Treatment Among African American Cocaine Users
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DOI：
10.1111/jrh.12092
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发表时间：
2015-12-01
影响因子：
4.9
通讯作者：
Curran, Geoffrey M.
中科院分区：
文献类型：
--
作者：
Borders, Tyrone F.;Booth, Brenda M.;Curran, Geoffrey M.
目的研究城乡居民的居住地、感知的可及性以及其他因素如何阻碍或促进与治疗利用密切相关的药物使用治疗的感知需求。研究设计通过受访者驱动的抽样方法招募200名未接受治疗的农村和200名城市非裔美国可卡因吸毒者，并完成结构化的面对面访谈。在双变量分析中，相对于城市可卡因吸毒者，农村可卡因吸毒者报告了更低的感知治疗需求(37%比48%)、可获得性、可获得性和有效性，以及对居住、门诊、自助和基于医院的服务的可接受性更低。在多变量分析中，城乡居住地与宗教咨询的可接受性之间存在显著的交互作用。在可接受性最高的水平上，农村用户感知需要的几率较低(OR=0.21)；在最低水平上，农村用户感知需求的几率高于城市用户(OR=3.97)。在农村使用者中，宗教咨询的可接受性与感知需要负相关(OR=0.65)。就医难易程度与就医难易程度呈负相关(OR=0.71)，而就医有效性(OR=1.47)和就医可接受性(OR=1.29)与就医意愿呈正相关。在农村和城市可卡因使用者中，改善治疗效果的感知和扩大以医院为基础的服务可以促进寻求治疗。
ObjectiveTo 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.Study DesignTwo 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).Principal FindingsIn 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.ConclusionsOur 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.