Opioid Overdose Literacy Among Black People in Deep South: The Role of Social Contact

Background and purposes: Opioid overdose is a national public health crisis in the US. Previous studies indicated that higher level of opioid literacy was negatively associated with opioid overdoses behaviors. Nonetheless, little research has examined the level of opioid knowledge exhibited among residents in rural settings. Social determinants of health (SDH), encompassing numerous individual, social, economic, and cultural conditions, have been identified as important contributors to health behaviors and health outcomes among rural adults. Therefore, this current study investigated the prevalence of opioid literacy, as well as the association between social determinants of health (SDH) and knowledge of opioid overdose risk among a sample of rural adults.

Methods: A total of 253 black people residing in a rural community in the southeastern United States were recruited in this cross-sectional study. The Brief Opioid Knowledge (BOOK) Questionnaire (0-12) was used to measure their levels of opioid literacy on three dimensions: 1) general opioid knowledge (0-4), 2) opioid overdose risk knowledge (0-4), and 3) opioid overdose response knowledge (0-4). Social determinants of health were examined on six key dimensions (i.e., household income status, educational attainment, employment, food insecurity, health literacy, and social contact). Demographic characteristic, health status, and health services access variables were included as control variables. Four multi-linear regression models were conducted to identify factors associated with total opioid knowledge, general opioid knowledge, opioid overdose risk knowledge, and opioid overdose response knowledge among this rural population. All the analysis was completed in Stata 14.

Findings: Results showed that participants tended to be not married/partnered (60.91%) female (75.00%) aged 51 years averagely. Most of them were bothered by pain (75.42%), had at least one chronic disease (94.86%), had health insurance (88.40%), primary physician (87.25%) and annual checkup (87.60%). The average scores on the total opioid knowledge, general opioid knowledge, opioid overdose risk knowledge, and opioid overdose response knowledge were 4.32 (SE=.22), 1.58 (SE=.09), 1.31 (SE=.09), and 1.43 (SE=.09), respectively. Logistic regressions showed that social contact was a consistently significant social determinant predictor for total opioid knowledge (b=.36, p<.05) and general opioid knowledge (b=.14, p<.05), and a marginal significant predictor for opioid overdose response knowledge (b=.13, p<.10). Besides, having a bachelor’s degree (b=.94, p<.10) and being employed (b=1.04, p<.10) were marginal significant social determinant predictors for total opioid knowledge. No other social determinants were found significant or marginal significant. In addition, age (b=-.03, p<.05; b=-.02, p<.01) and somewhat bothered by pain (b=-1.02, p<.05; b=-.54, p<.05) were consistently significant for total opioid knowledge and general opioid knowledge.

Conclusions and implications: Findings in this study indicated that people in rural south might have very low opioid knowledge (4.32 out of 12). Considering the consistent significant association between social contact and relevant opioid knowledge, more attentions should be focused on those who are socially isolated. Community-based interventions may be a good choice. Future education interventions can be organized or delivered in churches, community centers, and other public social places to reach out more relevant population.