Opioid Literacy in an Immigrant Group in Deep South: Addressing the Role of Social Determinants of Health

Background: The current study examined general opioid knowledge, overdose knowledge, and overdose response knowledge among Korean immigrants (KIs) residing in Alabama. The opioid epidemic is regarded as problematic in the United States, especially within Alabama because of high prescription rates. Nonetheless, opioid-related data among KIs residing in Alabama have not been studied. Also, health literacy, which has been found to be low among KI populations, is known to contribute to health disparities. As health literacy involves social, individual, and environmental factors, social determinant of health (SDH) framework was applied to explore the opioid literacy in KIs. The SDH examined were financial status, educational attainment, English proficiency, household food insecurity, health literacy, and social contact.

Methods: Data were collected using a cross-sectional survey design. A convenience sample of KIs aged 23 to 70, residing in Alabama (N= 230) was recruited from local churches. After explanation of the research purpose and survey procedure, the survey was distributed to the interested members and collected for 2 weeks. Opioid literacy was assessed using the Brief Opioid Overdose Knowledge (BOOK) survey. The original survey was written in English and translated into Korean using back-translation. The participants self-administered the survey in Korean. About half of the respondents were middle-aged and female, while 93% were married or partnered. About 34% had one or more chronic diseases, and about half reported to be somewhat to strongly bothered by pain. In terms of SDH, the average annual household income ranged between $45,000- $99,000, the highest completed education level was a college degree or higher, and the level of English proficiency of the sample was moderate. Also, low levels of household food insecurity were reported, along with moderate levels of health literacy, and two to three times a week of social contact. Univariate analyses were used for descriptive statistics, and a series of multiple linear regression analyses were conducted to examine the relationship between SDH and scores on the three sub-dimensions of opioid literacy along with overall literacy scores, adjusting for demographic and health status factors

Results: Overall, low levels of opioid literacy were found among the KIs residing in the rural south. After controlling for demographic and health variables, the relevant SDH variables associated with higher levels of overall opioid literacy were greater household income, better health literacy, and lower social contact. Specifically, respondents who were young or older, female, married, and with mild/moderate depression had higher general opioid knowledge than their counterparts. For overdose knowledge, those with chronic diseases and limited household income reported lower levels of knowledge. Poorer overdose response knowledge was associated with being male, having lower levels of health literacy, and more frequent social contact.

Implications: The findings suggest that culturally competent, community-level interventions are needed to increase opioid literacy and general health literacy as previous research have found language and culture-related variables to contribute to health disparities. Suggested strategies include community centers serving KIs, connection to health navigators or experts who speak the same language, and health materials in Korean.