Source: IOWA STATE UNIVERSITY submitted to NRP
UNDERSTANDING OPIOID RISKS IN RURAL AND MICROPOLITAN COMMUNITIES: ECONOMIC RESTRUCTURING, SOCIAL DISORGANIZATION, AND LOCAL RESPONSES
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
ACTIVE
Funding Source
AFRI COMPETITIVE GRANT
Reporting Frequency
Annual
Accession No.
1015248
Grant No.
2018-68006-27640
Cumulative Award Amt.
$498,401.00
Proposal No.
2017-08382
Multistate No.
(N/A)
Project Start Date
Jun 1, 2018
Project End Date
May 31, 2025
Grant Year
2018
Program Code
[A1661]- Innovation for Rural Entrepreneurs and Communities
Recipient Organization
IOWA STATE UNIVERSITY
2229 Lincoln Way
AMES,IA 50011
Performing Department
Sociology
Non Technical Summary
Rural communities in the U.S. are facing emerging challenges reflected in the opioid crisis. CDC data show that since 1999 the age-adjusted opioid-related mortality rate increased by 185% in metro areas, 693% in micropolitan areas, and 725% in noncore/rural areas. Trends in rural economic decline are implicated in and affected by the surge of the opioid crisis, but empirical research remains far too limited to inform policy and guide community development. The goal of our integrated research-extension project is to identify and disseminate effective place-based strategies that reduce opioid risks and hazards in rural and micropolitan communities experiencing social disorganization due to economic and farm restructuring. Key outcomes include reduction of opioid-related deaths, arrests, and prescribing rates and supply. There are five project objectives. First, to establish a national stakeholder advisory panel on non-metro opioid hazards. Second, to understand how economic restructuring, farm concentration, social disorganization, and government capacity affects opioid hazards across place and time using secondary data and multilevel structural models. Third, to understand effective local responses that increase community resilience or vulnerability to opioid hazards using qualitative case studies in 12 communities. Fourth, identify and disseminate to stakeholders place-based strategies that have been effective at reducing opioid hazards. Fifth, develop and deploy a real-time indicator of local opioid hazards using Big Data methods (web scraping and machine learning). This project addresses the AFRI (A1661) priorities for rural communities, as the opioid crisis is a pressing rural problem that negatively affects economic development, local government and social services, and social inequality.
Animal Health Component
60%
Research Effort Categories
Basic
40%
Applied
60%
Developmental
0%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
8036050308075%
8056050208025%
Knowledge Area
805 - Community Institutions, Health, and Social Services; 803 - Sociological and Technological Change Affecting Individuals, Families, and Communities;

Subject Of Investigation
6050 - Communities, areas, and regions;

Field Of Science
2080 - Mathematics and computer sciences; 3080 - Sociology;
Goals / Objectives
Rural communities in the U.S. are facing emerging challenges reflected in the opioid crisis. CDC data show that since 1999 the age-adjusted opioid-related mortality rate increased by 185% in metro areas, 693% in micropolitan areas, and 725% in noncore/rural areas. Trends in rural economic decline are implicated in and affected by the surge of the opioid crisis, but empirical research remains far too limited to inform policy and guide community development.The goal of our integrated research-extension project is to identify and disseminate effective place-based strategies that reduce opioid risks and hazards in rural and micropolitan communities experiencing social disorganization due to economic and farm restructuring. There are five project objectives.Objective 1:Establish a national stakeholder advisory panel on non-metro opioid hazards.Objective 2:Understand how economic restructuring, farm concentration, social disorganization, and government capacity affects opioid hazards across place and time using secondary data and multilevel structural models.Objective 3: Understand effective local responses that increase community resilience or vulnerability to opioid hazards using qualitative case studies in 12communities.Objective 4: Identify and disseminate to stakeholders place-based strategies that have been effective at reducing opioid hazards.Objecitve 5:Develop and deploy a real-time indicator of local opioid hazards using Big Data methods (web scraping and machine learning).
Project Methods
Our primary outcome is opioid hazard (OPIOIDHAZ), a latent variable comprised of opioid-related arrests, deaths, and prescription supply. Existing studies of opioid use disorders (OUDs) use only a single outcome indicator, typically mortality rates. We argue that opioid hazard is a multidimensional concept encompassing deaths (health and mortality outcome indicative of overdoses and extreme abuse), arrests (criminological outcome indicative of illegal possession and distribution), and prescriptions (supply outcome indicative of opioid availability that may lead to misuse or illegal trafficking/diversion).Covariates associated with opioid hazard will be compiled from a number of secondary data sources back to 1990, or nearest year, to examine their trends. Economic restructuring is measured using decline in good-producing industries and farm concentration, which are common measures used in rural sociology. Research in criminology has identified common indicators of social and physical disorganization. Social disorganization (SOCDISORG) includes rates of poverty and income inequality, crime rates, and social capital using civic association measures. Physical disorganization (PHYDISORG) is measured by housing conditions, presence of essential services, and spatial crime indicators like proximity drug trafficking corridors. Governments may have the capacity to intervene in economic and social drivers of opioid hazard. We examine capacity using county and state level variables.Multilevel structural equation models (MLSEMs) represent a synthesis of multilevel regression models and structural equation models. The motivation for multilevel models is to appropriately model counties nested within states, by partitioning the variance in opioid hazard to within-state and between-state differences. Our primary dependent variable is latent opioid hazard, but we will also estimate models for each component of the opioid scale.Based on the regression results in objective 2, we will identify counties that had better-than-expected (opioid-resistant) and worse-than-expected (opioid-vulnerable) opioid hazards given their socioeconomic and demographic conditions. The opioid-resilient group includes counties whose opioid hazard residuals were better than predicted (1.5 std dev or more below the mean) despite having high base hazard risk. By contrast, the opioid-vulnerable group includes high-hazard counties with worse than predicted residuals (1.5 std dev or more above the mean). Once identified, basic statistical measures will be used to describe the two groups using condition means and related difference tests. Next, we will select n=6 counties from each opioid response group (for as total of 12 counties) using propensity score matching (PSM) techniques. This will create a set of 12 paired counties that have maximum differences in opioid hazard but are highly similar in socioeconomic context.We will collect primary data from opioid-resistant and opioid-vulnerable places from residents, government officials, criminal justice professionals, and health and social services providers. We will use interviews, focus groups, and content analysis of local news media to better understand local conditions and efforts related to opioids. Based on this corpus of data, we will use a modified variant of Grounded Theory method to identify emergent themes and specify relationships between them in order to build a theory of how local community responses play a role in why some communities appear more resilient against opioid hazards while others appear more vulnerable, despite socioeconomic similarity.Understanding the structural factors of opioid hazards and local responses are important research questions. Equally important, however, is to identify the exact strategies places have used to help their communities be resilient to opioid hazards. Put another way, it is equally important to identify place-based strategies that are useful to and actionable by community groups to reduce opioid risk and increase resiliency against this (and future) drug epidemics. Synthesizing findings from objectives 2 and 3, we will formulate a set of best practices and strategies that local officials and leaders can deploy to minimize the negative effects of opioid abuse in their community. We then will develop extension materials and disseminate them to broader stakeholders and the general public.Due to the lag in data publication (which is often delayed by a year or more) and suppression (which often occurs in low population rural geographies) of official opioid risk data, there is a need to develop new and novel indicators which can be used to estimate opioid hazards at the local level. We propose the generation of real-time indicators correlated with current opioid hazard indicators using machine learning techniques and feature extraction, techniques that can be applied to publically available and crowd sourced data. Using the six opioid-resilient and six opioid-vulnerable communities (high risk-better-than-expected; high risk-worse than expected) identified in objective 3 as pilot cases, we will scrape data from local news websites, social media, city data resources, and correlate these findings with opioid hazards and local responses. Because these places were selected to maximize opioid response difference and minimize other difference, only a small number may be needed for Big Data validation. The analytic strategy is to collect and create measures of: (i) opioid incidence that relates to opioid arrests, deaths, and prescription supply, validated by objective 2; (ii) opioid awareness that relates to responses from the community, criminal justice system, and health and social services providers, validated by objective 3; and (iii) opioid action that relates to specific actions or policies undertaken by the community to address opioid hazards, validated by objective 4.Specifically, we will divide past data on opioid hazards using k-fold cross validation; and utilize historical and archived data sets to generate classifiers in real time to predict the levels of future opioid incidence, awareness, and action. We will correlate these with public data on policy discussions, meeting minutes, editorial articles, letters to the editor, and other materials indicating the presence of opioid hazards. We will perform sentiment analysis and coding on the natural language data to provide additional qualitative features to accompany quantitative features from objectives 2 and 3. The model will consist of non-parametric classifiers built through the application of hierarchical learning methods, also called deep learning, generating features from multi-dimensional data grouped into observations on the basis of temporal, spatial, and network structures.

Progress 06/01/23 to 05/31/24

Outputs
Target Audience:Researchers in public health, rural sociology, and criminology. Professionals and practitioners in extension, public health, substance abuse, and law enforcement. State and local policy makers in opioid-impacted rural communities. Specific audiences this reporting period were legal scholars and local attorneys in rural communities that face a shortage of legal professionals to deal with the opioid crisis. One new avenue of research and extension was the impact of the opioid crisis in "rural legal desert" communities. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?HOCHSTETLER, A., D.J. Peters, G. Sterner III, S. Monnat. 2024. Enhancing intelligence practice through networks: Expanding drug intelligence capacity. Western Society of Criminology, February, Long Beach, CA. Hochstetler, A. and D.J. Peters 2023. New Intelligence Strategies for Police. Annual meeting of International Association of Chiefs of Police. September, San Diego, CA. What do you plan to do during the next reporting period to accomplish the goals?We will continue to code the qualitative data to identify effective and ineffective opioid risk reduction practices. We will group these by state, then look for regional similarities. We do not expect there to be any national similarities. Once the qualitative analysis has been completed, we will create extension bulletins and curricula on best practices to address rural opioid addiction at the local level using local resources. We will create a final report. We will also develop academic papers to publish these results.

Impacts
What was accomplished under these goals? Objective 3: In July 2023, PIs traveled to West Virginia for 2.5 weeks to conduct qualitative interviews and focus groups in 12 communities across 6 counties. There were 24 in-depth interviews with local leaders in law enforcement, addiction services, mental heathcare, healthcare, social services, and local government officials. We also conducted another 8 focus groups that included some 180 persons. We also conducted 4 interviews in adjacent counties in Virginia and Kentucky due to proximity. In September 2023, PIs traveled to New Mexico for 12 days to conduct qualitative interviews and focus groups in 5 communities across 5 counties. This required long driving times as the counties were across the state. Further, these rural counties only had on sizable population center. We completed 15 interviews across the 5 communities and held 5 focus groups in which 90 persons attended. Participants included law enforcement, addiction, and mental health service providers, social services, religious groups that provide services, tribal leaders, and local government officials. Data were audio recorded and were transcribed using Otter.ai. Student workers corrected the transcriptions by listening to the audio files. Interviews were coded to identify emerging themes first within counties/communities, then secondly within states. This coding process is ongoing.

Publications

  • Type: Conference Papers and Presentations Status: Published Year Published: 2024 Citation: HOCHSTETLER, A., D.J. Peters, G. Sterner III, S. Monnat. 2024. Enhancing intelligence practice through networks: Expanding drug intelligence capacity. Western Society of Criminology, February, Long Beach, CA.
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2023 Citation: Hochstetler, A. and D.J. Peters 2023. New Intelligence Strategies for Police. Annual meeting of International Association of Chiefs of Police. September, San Diego, CA.


Progress 06/01/22 to 05/31/23

Outputs
Target Audience:Researchers in public health, rural sociology, and criminology. Professionals and practitioners in extension, public health, substance abuse, and law enforcement. State and local policy makers in opioid-impacted rural communities. Specific audiences this reporting period were legal scholars and local attorneys in rural communities that face a shortage of legal professionals to deal with the opioid crisis. One new avenue of research and extension was the impact of the opioid crisis in "rural legal desert" communities. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?We presented results of our findings to federal officials at the US Dept of Justice, as well as giving training sessions to DOJ staff. These activities are presented below. *Hochstetler, A., D.J. Peters and G. Sterner III. 2023. Professional Development Training. "Strategies to BuildDrug Intelligence Networks to Combat the Opioid Crisis in Rural Communities: A Collaborative Harm-Reduction Strategy." Training given to the National Institute of Justice'sIntelligence Grant Working Group, April 18, in Washington, D.C. Hochstetler, A., D.J. Peters and G. Sterner III. 2023. Invited presentation."Building Opioid Intelligence and Incident Mapping".Presented to the National Institute of Justice andBureau of Justice Assistance, COSSAP annual meeting, May 8, in Washington, D.C. Hochstetler, A., D.J. Peters and G. Sterner III. 2023. Professional Development Training. "Opioid Intelligence and Overdose Survelliance Techniques for Rural Communities. Training given to staff in the National Institute of Justice and Bureau of Justice Assistance, COSSAP annual meeting, May 9, in Washington, D.C. Hochstetler, A., D.J. Peters and G. Sterner III. 2023. Invited presentation. "Building Drug Intelligence Networks to Combat the Opioid Crisis in Rural Communities: A Collaborative Intelligence-led Harm-Reduction Strategy between Police and Providers". Presented to theNational Institute of Justice Research Conference, May 23, in Washington, D.C. Academic presentations. *Hochstetler. A. 2023. "Drug Research in Rural Areas and Hochstetler Agenda". University of Texas at Dallas. Department of Sociology and Criminology. March. Rios Martinez, N.& Peters, D. 2022. "Understanding Rural Legal Deserts in the United States" Presented at the Rural Sociological Society Annual Meeting, August in Westminster, CO. What do you plan to do during the next reporting period to accomplish the goals?Visit communities in 11 counties in New Mexico and West Virginia in summer and fall 2023. Visit communities in the Northeast in summer 2024. Write extension bullentins and academic papers on effective strategies to reduce opioid overdose.

Impacts
What was accomplished under these goals? Objectives 2,3,4: Published three papers in criminology journals based on the CDC death certificate data, as well as community interviews completed to date. One paper published in the Journal of Criminal Justice identified poly-substance drug overdose clusters across all counties in the US, using CDC data. We found that while some rural counties have only have opioid overdose problem, others have a mainly methamphetamine death problem with no opioid abuse. A small number had high mortality rates from both opioids and meth. The correlates of meth mortality are very similar to opioids, suggesting that local preferences and access to drugs may explain why some counties have a meth rather than an opioid problem. Another paper published in the American Journal of Criminal Justice presented initial results from our qualitative community visits. In this mixed method paper, we presented how we selected case study communities based on a statistical technique that classified rural counties as either resilient or vulnerable to opioid mortality. The remainder of the paper describes the results of our qualitative analysis on local responses and local cultures that made some places resilient and other vulnerable despite having statistically the same risk factors. Objective 3: Contacted selected counties in West Virginia and New Mexico to plan site visits during the next 6 months. We have spoken with government officials, law enforcement, substance abuse treatment providers, lawyers, and non-profits in each county to get their agreement to meet with us during the week of our visit. We will visit five counties in West Virginia in summer 2023; and six counties in New Mexico in fall 2023. We also updated our interview protocols and obtained IRB approval for the changes. Objective 4: Based on our initial interviews and conversations with local communities, we found that a shortage of local attorneys is a major barrier to addressing the opioid crisis. This includes prosecutors and defense attorneys for criminal proceedings, but the major issue is not enough family lawyers to deal with issues related to children, divorce, assets, and civil commitment. To better understand this, we have used Census business establishment data to identify "legal deserts" in rural counties to see if there is a correlation between a lack of attorneys and opioid resiliency or vulnerability. A paper was presented at a professional conference on this topic. Objective 5: Develop a desktop tool to assist rural communities in estimating how changes in demographics, social conditions, drug risk factors, treatment provision, and work in injury-prone jobs may increase or decrease opioid overdose risk. The tool allows local leaders to run "what-if" scenarios to anticipate changes or to assess program impacts.

Publications

  • Type: Peer Reviewed Journal Articles Status: Published Year Published: 2023 Citation: Hochstetler, A. & Peters, D. 2023. Geography of Poly-Substance Drug Mortality. Journal of Criminal Justice 86:102044. (JCR=5.05)
  • Type: Peer Reviewed Journal Articles Status: Published Year Published: 2022 Citation: Hochstetler, A., Peters, D., & Monnat, S. 2022. Prescription Opioid Resiliency and Vulnerability: A Mixed-Methods Comparative Case Study. American Journal of Criminal Justice 47:651-671.
  • Type: Peer Reviewed Journal Articles Status: Published Year Published: 2022 Citation: DeLisi, M., Peters, D., Hochstetler, A., Butler, H., & Vaughn, M. 2022. Psychopathy among Condemned Capital Murderers." Journal of Forensic Sciences 68:558-567.


Progress 06/01/21 to 05/31/22

Outputs
Target Audience:COVID-19 travel restrictions hampered a large part of grant activities between June 2021 to May 2022. Intended community site visits had to be canceled and delayed indefinitely, as public health officials were focused on COVID issues instead of opioids. In the interim, the team continued to analyze data, virtually present papers at national conferences, and publish a few articles. COVID-19 will delay this project until December 2023 to provide time to complete the community site visits and to identify effective strategies. The team will be seeking a secondextension. Changes/Problems:As stated previously, COVID has radically altered this projectas the public health focus shifted towards the pandemic. As COVID cases and deaths have dropped, our communities are now beginning to address the drug problemonce again. One major issue is reconciling interviews from the pre-COVID community site visits with those done post-COVID. The research team has decided to re-interview people from 2019 to assess how the opioid problem has changed. Another issue is objective 5, which seeks to develop a real-time opioid risk indicator. Two issues. First,co-PI Rozier left Iowa State University and academia for the private sector. Second, before his departure, Rozier had limited success at scraping data from local newspapers and website to develop the indicator. Issues were (1) many case study communities did not have newspapers; (2) extant newspapers rarely reported overdose deaths; (3) 911 calls for service were not publically available, but had to be requested for each county; and (4) in counties where web informationexisted, the risk indicator exhibited poor fit. We are now thinking to change objective 5 away from a real-time risk indicator to using machine learning to estimate the opioid overdose undercount in CDC data. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?The project team has presented results at (1) national academic conferences; and(2) undergraduate classes in the Northeast and Midwest. What do you plan to do during the next reporting period to accomplish the goals?Our priority is to complete outstanding community site visits, which have been delayed due to COVID-19 travel restrictions. Once completed, the interview data will be analyzed and merged with secondary data. We will then begin the process of identifying strategies and developing curricula. COVID has radically altered this project, as the public health focus shifted towards the pandemic. As COVID cases and deaths have dropped, our communities are now beginning to address the drug problem once again.

Impacts
What was accomplished under these goals? Objective 1: Establish a national stakeholder advisory panel on non-metro opioid hazards. Held one virtual meeting to give a brief overview of how teh project is progressing during COVID. Objective 2: Understand how economic restructuring, farm concentration, social disorganization, and government capacity affect opioid hazards across place and time using secondary data and multilevel structural models. Wrote and submitted two papers and presented one at a national conference. Papers were based on new CDC mortality data requested during the previous year (e.g. 2017-2019 vintage data). Objective 3: Understand effective local responses that increase community resilience or vulnerability to opioid hazards using qualitative case studies in 12 communities. COVID-19 has impacted our ability to visit communities. However, we have been in contact with our case study sites to continue teh relationship and to ask when a on-site visit woudl be appropriate. We have conducted follow-up interviews in 4 towns we visitedpre-COVID to assess how the drug problem has changed during COVID. Objective 4: Identify and disseminate to stakeholders place-based strategies that have been effective at reducing opioid hazards. Using updated community data from objectives 2 and 3, we have been revising our effective strategies. These have been presented at professional conferences. However, the findings are preliminary since we have been unable to visit all communities due to COVID. Objecitve 5: Develop and deploy a real-time indicator of local opioid hazards using Big Data methods (web scraping and machine learning). Scraped web data in the 12 case study communities (from webpage archive sites) and usedmachine learning techniques to approximate opioid overdose deaths in 2018 and 2019. Rozier had limited success at scraping data from local newspapers and other websites. Issues were (1) many case study communities did not have newspapers; (2) extant newspapers rarely reported overdose deaths; (3) 911 calls for service were not publically available, but had to be requested for each county; and (4) in counties where web informationexisted, the risk indicator exhibited poor fit. Explored machinelearning methods to estimate the opioid overdose undercount in CDC data.

Publications

  • Type: Journal Articles Status: Accepted Year Published: 2022 Citation: Hochstetler, A., Peters, D., & Monnat, S. Prescription Opioid Resiliency and Vulnerability: A Mixed-Methods Comparative Case Study. American Journal of Criminal Justice. (JCR=6.04)
  • Type: Journal Articles Status: Under Review Year Published: 2022 Citation: Hochstetler, A. & Peters, D. Geography of Poly-Substance Drug Mortality. International Journal of Drug Policy. (JCR=5.01)
  • Type: Conference Papers and Presentations Status: Published Year Published: 2021 Citation: Hochstetler, A., Peters, D., & Slemaker, A. Exploring Opioid Prescription Overdose: Remoteness and Response in the Rural U.S. Presented at the American Society of Criminology Annual Meeting, November 2021 in Chicago, IL.


Progress 06/01/20 to 05/31/21

Outputs
Target Audience:COVID-19 travel restriction hampered a large part of grant activities between June 2020 to May 2021. Intended community site visits had to be canceled and delayed indefinitely, as public health officials were focused on COVID issues instead of opioids. In the interim, the team continued to analyze data, virtually present papers at national conferences, and publish a few articles. COVID-19 will delay this project one year, and the team will be seeking an extension. Changes/Problems:Major COVID-19 disruptions have impacted our ability to conduct community site visits. We will be requesting a one-year extension to complete the work. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?The project team has presented results at (1) national academic conferences: (2)presented at federal agencies like the Office of National Drug Control Policy and the National Institutes of Health HEAL Initiative; and (3) at undergraduate and graduate classes in the Northeast and Midwest. What do you plan to do during the next reporting period to accomplish the goals?Our priority is to complete outstanding community site visits, which have been delayed due to COVID-19 travel restrictions. Once completed, the interview data will be analyzed and merged with secondary data. We will then begin the process of identifying strategies and developing curricula.

Impacts
What was accomplished under these goals? Objective 1:Establish a national stakeholder advisory panel on non-metro opioid hazards. Held one virtual meeting. Objective 2:Understand how economic restructuring, farm concentration, social disorganization, and government capacity affect opioid hazards across place and time using secondary data and multilevel structural models. Obtained 2018 data to update models. Published two papers and presented them at national conferences. Objective 3: Understand effective local responses that increase community resilience or vulnerability to opioid hazards using qualitative case studies in 12communities. COVID-19 has impacted our ability to visit communities. However, visited two communities in the winter of 2021. Objective 4: Identify and disseminate to stakeholders place-based strategies that have been effective at reducing opioid hazards. Using existing community data from objectives 2 and 3, we had identified effective strategies. These have been presented at professional conferences. However, the findings are preliminary since we have been unable to visit all communities due to COVID. Objecitve 5:Develop and deploy a real-time indicator of local opioid hazards using Big Data methods (web scraping and machine learning). Nothing to report.

Publications

  • Type: Journal Articles Status: Published Year Published: 2020 Citation: Cushing, B., Erfanian, E. & Peters, D. (2020) The National Drug Crisis - What Have We Learned from the Regional Science Disciplines. Review of Regional Studies 50:353-382. https://rrs.scholasticahq.com/article/18236
  • Type: Journal Articles Status: Published Year Published: 2020 Citation: Peters, D., Monnat. S., Hochstetler, A., & Berg, M. (2020) The Opioid Hydra: Understanding Mortality Epidemics and Syndemics Across the Rural-Urban Continuum. Rural Sociology 85:589-622. https://doi.org/10.1111/ruso.12307 (JCR=4.08) *Top 10% Downloaded Paper.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2021 Citation: Hochstetler, A., Peters, D., & Slemaker, A. (2021) Exploring Opioid Prescription Overdose: Remoteness and Response in the Rural U.S. Presented at the American Society of Criminology Annual Meeting, November in Chicago, IL.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2021 Citation: Peters, D., Monnat, S., & Hochstetler, A. (2021) Geography of Polysubstance Drug Mortality: Place and Policy Effects. Presented at the Southern Regional Science Association Annual Meeting, April via web conference.
  • Type: Journal Articles Status: Under Review Year Published: 2021 Citation: Hochstetler, A., Peters, D., & Monnat, S. Prescription Opioid Resiliency and Vulnerability: A Mixed-Methods Comparative Case Study. Under review in Journal of Rural Studies.


Progress 06/01/19 to 05/31/20

Outputs
Target Audience:Researchers in Public Health, Rural Sociology, and Regional Science. Professionals and practitioners in extension, public health, 4-H, and law enforcement. State and local policy makers in opioid-impacted rural communities. Changes/Problems:Year 3 will focus on completing community site visits that have been delayed due to COVID-19. At present, we anticipate community revisits may be allowed in late spring or early summer of 2021. Year 3 will also secure a new data science co-PI after the initial one left academia. We have a faculty member at the U of Nebraska-Lincoln who has agreed to assume the data science tasks, pending a new subaward. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?Presentations at National Conferences 2019 Meadowcroft, D.†,Peters, D., & Whitacre, B. "Impact of State Prescription Drug Monitoring Programs on County Opioid Mortality, 2000-2016". Presented at theNorth American Meetings of the Regional Science Association International, November in Pittsburgh, PA. 2019Peters, D.& Monnat, S. "Understanding Opioid Resiliency and Vulnerability in Rural and Micropolitan Communities" Presented at theNorth American Meetings of the Regional Science Association International, November in Pittsburgh, PA. 2019Peters, D., Monnat, S., & Hochstetler, A. "The Opioid Hydra, Crime, and Community." Presented at theAmerican Society of Criminology Annual Meeting, November in San Francisco, CA. 2019 Hochstetler, A.,Peters, D., Sterner, G., Berg, M., & Monnat, S. "Opioid Use and Homicide at the County-Level: Drug Markets as Structural Mediators." Presented at theAmerican Society of Criminology Annual Meeting, November in San Francisco, CA. 2019Peters, D., Monnat, S., Hochstetler, A., & Berg M. "Identifying Opioid-Use Mortality Epidemics and Syndemics Across Space." Presented at theRural Sociological Society Annual Meeting, August in Richmond, VA. 2019 Berg, M., Hochstetler, A.,Peters, D., & Monnat, S. "Drug Crime Connections in U.S. Counties: Assessing Structural Effects, Opioid Use and Homicide at the County-level." Presented at theRural Sociological Society Annual Meeting, August in Richmond, VA. Monnat, S. "The Roles of Socioeconomic and Opioid Supply Factors in U.S. Drug Mortality: Urban-Rural and Within-Rural Differences". Presented at European Society for Rural Sociology Annual Meeting, June, Trondheim, Norway. Media Coverage "Stand up and be counted for research's sake." Link: Magazine for the College of Liberal Arts and Sciences, published 5/4/2020. https://link.las.iastate.edu/2020/05/04/stand-up-and-be-counted-for-researchs-sake "Iowa State professor finds there's more than one opioid epidemic occurring." Ames Tribune, published 12/14/2019. https://www.amestrib.com/news/20191214/iowa-state-professor-finds-there8217s-more-than-one-opioid-epidemic-occurring "This map shows how the opioid epidemic varies in different parts of the US." The Boston Globe, published 12/11/2019. https://www.bostonglobe.com/2019/12/11/metro/this-map-shows-how-how-opioid-epidemic-is-different-different-parts-us "ISU study finds causes of opioid deaths vary by region." Radio Iowa, aired 12/10/2019. https://www.radioiowa.com/2019/12/10/isu-study-finds-causes-of-opioid-deaths-vary-by-region "U.S. Facing 'Syndemic' of Opioid Overdoses." Pain News Network, published 12/10/2019. https://www.painnewsnetwork.org/stories/2019/12/10/us-facing-syndemic-of-opioid-overdoses What do you plan to do during the next reporting period to accomplish the goals?Year 3 will focus on completing community site visits that have been delayed due to COVID-19.At present, we anticipate community revisits may be allowed in late spring or early summer of 2021.After completion, the team will start analyzing the qualitative data using Grounded Theory to identifiy emergent strategies to prevent opioid risk.

Impacts
What was accomplished under these goals? The secondyear, or our integrated research-extension project focused on opioid risks and hazards,was spent obtaining primary and secondary data. For primary data, additional confidential CDC data for 2017 and 2018 was obtained to validate models run using 2016 data. New CDC data will also be used in secondary analyses to be published in sociological, public health, and criminology journals. For secondary data, four community site visits were conducted in Tennessee and Colorado, consisting on 12-15 interviews and at least one community focus group. Results from pubished work was presented at professional conferences and featured in state and national news media. The major impact of year 2 activities was identification of not a single opioid epidemic, but rather five simultaneous epidemics occurring within distinct regions of the US. This helps state and local policy makers identify the specific opioid problem affecting their community; and to tailor specific intervention strategies to reduce drug abuse and mortality. Objective 1... Establish a national stakeholder advisory panel on non-metro opioid hazards. Advisory panel meet once during the reporting period to review interview protocols. Objective 2... Understand how economic restructuring, farm concentration, social disorganization, and government capacity affects opioid hazards across place and time using secondary data and multilevel structural models. In year 2, we obtained access to 2017 and 2018 CDC confidential multiple-cause of death data, extending the time series from 2016. We also collected a wide variety of secondary data from BEA, BLS, Census, ERS-USDA, FBI, and HHS. Data were harmonized across space (counties) and periods (back to 1990). We identified opioid-resilient counties (better than predicted with low observed mortality), opioid-coping counties (better than predicted yet high observed mortality), opioid-vulnerable (predicted low, but observed mortality high), and opioid-endangered (predicted high, but observed mortality was much higher). This was done for overall opioid mortality, but also for specific types of mortality including prescription-only, heroin-only, and multiple-opioid causes. Objective 3... Understand effective local responses that increase community resilience or vulnerability to opioid hazards using qualitative case studies in 12 communities. Completed four community visits in Tennessee (n=2) and Colorado (n=2) based on the resilient-vulnerable typology identified in objective 2. Data collected in Fall 2019. In each community we completed 12-15 interviews, conducted at least one focus group, completed two "windshield surveys" of various communities in the county, and documented the county in pictures. COVID-19 travel restrictions prevented planned travel in Spring 2020, delaying data collection. Objective 4... Identify and disseminate to stakeholders place-based strategies that have been effective at reducing opioid hazards. Nothing to report, as community site visits are not complete. Objective 5... Develop and deploy a real-time indicator of local opioid hazards using Big Data methods (web scraping and machine learning). Co-PI Rozier left the project and Iowa State U. to pursue employment in the private sector. NIFA relocation to Kansas City, MO delayed a change of PI request. New co-PI at U of Nebraska has agreed to assume the data science role.

Publications

  • Type: Journal Articles Status: Published Year Published: 2020 Citation: Peters, D., Monnat. S., Hochstetler, A., & Berg, M. 2020. The Opioid Hydra: Understanding Mortality Epidemics and Syndemics Across the Rural-Urban Continuum. Rural Sociology 85: 589-622. https://doi.org/10.1111/ruso.12307
  • Type: Journal Articles Status: Submitted Year Published: 2020 Citation: Peters, D., Hochstetler, A., & Monnat, S. Understanding Opioid Resiliency and Vulnerability in Rural and Micropolitan Communities.
  • Type: Other Status: Published Year Published: 2019 Citation: Monnat, Shannon M. 2019. There are Multiple and Geographically Distinct Opioid Crises in the U.S. Research Brief. Lerner Center Population Health Research Brief Series. https://lernercenter.syr.edu/2019/06/24/there-are-multiple-and-geographically-distinct-opioidcrises-in-the-u-s/


Progress 06/01/18 to 05/31/19

Outputs
Target Audience:Researchers in Public Health, Rural Sociology, and Regional Science. Professionals and practitioners in extension, public health, 4-H, and law enforcement. State and local policy makers in opioid-impacted rural communities. Changes/Problems:Co-PI Davis Rozier took a leave of absence from Iowa State U. starting in September 2018. He resigned from the university and left academia for the private sector in May 2019. We have found a replacement co-PI at Iowa State U. to fulfill his tasks. She is Dr. Susan Vanderplas, Research Assistant Professor of Statistics at Iowa State U. Our Office of Sponsored Programs is working with USDA to effect the removal and addition. What opportunities for training and professional development has the project provided?Continuing education training sessions (for credit) provide via webinar for the National Network of Libraries of Medicine Libraries of Medicine and US Army National Guard Counterdrug Taskforce. Peters, D. "The Opioid Hydra: Understanding Mortality Epidemics and Syndemics Across the Rural-Urban Continuum." Presented to National Network of Libraries of Medicine, May 2019 via webinar. Peters, D. and Hochstetler, A. "Identifying Opioid-Use Mortality Clusters for Use in Drug Intelligence." Presented to the Civil Operations Annual Summit, Army National Guard, April 2019 in Reno, NV. How have the results been disseminated to communities of interest?Results have been presented at practitioner and academic professional conferences, including: National Network of Libraries of Medicine Libraries of Medicine, US Army National Guard Counterdrug Taskforce, state Departments of Public Health, and community organizations. We have also developed a project website and have generated sizable media coverage about the project and results. Presentations Peters, D., Monnat, S., & Hochstetler, A. "Opioid-Use Mortality Epidemics." Presented at the Southern Regional Science Association Annual Meeting, April 2019 in Washington, DC. Hochstetler, A., Peters, D. 2019. "A pressing threat to working-class America. Logistics and spatial dynamics of opioids." Ames, IA, Kiwanis Club. March 15, 2019. Peters, D. "Health Communities, Health Newspapers." Presented to the Iowa Newspaper Association Annual Conference, February 2019 in Des Moines, IA. Peters, D. "The Opioid Hydra: Heterogeneity in Opioid-Use Disorder Mortality and Implications for Public Health." Presented to the State Epidemiological Workgroup, Iowa Department of Public Health, December 2018 in Des Moines, IA. Monnat, S. 2019. Alcohol Research Group, Emeryville, CA Monnat, S. 2018. Population Association of America Congressional Briefing, Washington, DC Media Coverage "Research Highlight: Geography of Opioid Overdoses" UI News, published 6/21/2019. http://ppc.uiowa.edu/news/2019/06/21/research-highlight-geography-opioid-overdoses "Synthetic opioids on the rise in Iowa" River to River, Iowa Public Radio, aired 2/15/2019. https://www.npr.org/podcasts/487793356/river-to-river or https://www.iowapublicradio.org/podcasts/36/rss.xml "Synthetic opioids pose new concerns: Channel 13 News at 4pm." WHO-TV Des Moines, aired 2/13/2019. https://whotv.com/category/news/ "ISU researcher: increase in drug overdose deaths from illegal substances on horizon" Radio Iowa, aired 2/13/2019. https://www.radioiowa.com/2019/02/13/isu-researcher-increase-in-drug-overdose-deaths-from-illegal-substances-on-horizon "Opioid problem in Iowa shifting to heroin, synthetics, Iowa State report shows" Cedar Rapids Gazette, published 2/13/2019. https://www.thegazette.com/subject/news/health/iowa-opioid-addiction-iowa-state-university-synthetics-shift-heroin-overdose-20190213 Sioux City Journal, published 2/13/2019. https://siouxcityjournal.com/news/state-and-regional/iowa/opioid-problem-in-iowa-shifting-to-heroin-synthetics-iowa-state/article_d97cf36e-6210-5c4b-aa11-5a8b6a7e9ceb.html} Waterloo-Cedar Falls Courier, published 2/14/2019. https://wcfcourier.com/news/local/govt-and-politics/opioid-problem-in-iowa-shifting-to-heroin-isu-report-shows/article_28a507f0-475b-5041-bb7b-23318edae4bb.html "Study predicts more heroin, fentanyl addiction in Iowa" WHO Radio News, aired 2/12/2019. https://whoradio.iheart.com/featured/who-radio-news/content/2019-02-12-study-predicts-more-heroin-fentanyl-addiction-in-iowa/ "Prescription opioid overdose deaths falling in Iowa; synthetics and heroin spike new concern" ISU News Service, published 2/11/2019. https://www.news.iastate.edu/news/2019/02/11/opioiddeaths "New opioid study: This Week in Iowa" WOI-TV Des Moines, aired 9/23/2018.https://www.weareiowa.com/news/politics/this-week-in-iowa-9-23-18/1471689051 What do you plan to do during the next reporting period to accomplish the goals?Year 2 will be fully devoted to convening the advisory panel (Objective 1); and conducting the community case study visits in 16 opioid resilient, coping, vulnerable, and endangered communities (Objective 3). We will also begin work on the big data opioid risk indicator (Objective 5), but deploying the ODmap mobile application in the 16 communities and collecting the data via API (with permission).

Impacts
What was accomplished under these goals? The first year was spent obtaining confidential data and running secondary analyses in order to identify community case study sites, where qualitative data will be collected and analyzed to identify effective opioid reduction strategies in year two. Administratively, year one was spent organizing the research team and developing human subjects protocols. We also engaged in a sustained outreach effort to make the project known to key stakeholders. This involved training sessions, presentations at professional conferences, and news stories. Objective 1... Establish a national stakeholder advisory panel on non-metro opioid hazards. In year 1, we created a list of key stakeholders in states where will conduct community case studies in Objective 3. Counties and states were identified in Objective 2. Objective 2... Understand how economic restructuring, farm concentration, social disorganization, and government capacity affects opioid hazards across place and time using secondary data and multilevel structural models. In year 1, we obtained access to CDC confidential multiple-cause of death data, a process that took three months to complete. We also collected a wide variety of secondary data from BEA, BLS, Census, ERS-USDA, FBI, and HHS. Data were harmonized across space (counties) and periods (back to 1990). We computed measures of opioid overdose mortality by detailed drug type and pairings of multiple opioids. Data were analyzed using exploratory spatial data analysis, descriptive statistics, predictive models, and classification techniques. Residuals analysis was also performed to identify community case study sites. Covariates were grounding in recent opioid literatures. Objective 3... Understand effective local responses that increase community resilience or vulnerability to opioid hazards using qualitative case studies in 12 communities. Based on statistical models and residuals analysis in Objective 2, we have identified opioid-resilient counties (better than predicted with low observed mortality), opioid-coping counties (better than predicted yet high observed mortality), opioid-vulnerable (predicted low, but observed mortality high), and opioid-endangered (predicted high, but observed mortality was much higher). We selected 16 counties to visit in year 2. We also revised the interview and focus group protocols; and have also performed a news/web seach for each of the 16 counties to gain more information about community context. Objective 4... Identify and disseminate to stakeholders place-based strategies that have been effective at reducing opioid hazards. Nothing to report. Objective 5... Develop and deploy a real-time indicator of local opioid hazards using Big Data methods (web scraping and machine learning). Nothing to report.

Publications

  • Type: Journal Articles Status: Published Year Published: 2019 Citation: Monnat. S., Peters, D., Berg, M., & Hochstetler, A. 2019 Using Census Data to Understand County-Level Differences in Opioid Mortality Rates. American Journal of Public Health 109: 1084-1091. https://doi.org/10.2105/AJPH.2019.305136 (JCR=5.38, SJR=4.21)
  • Type: Other Status: Published Year Published: 2019 Citation: Peters, D., Miller, P.*, & Hochstetler, A. 2019 Understanding the Rural Opioid Crisis in Rural and Urban Iowa. SOC 3088, January. Iowa State University Extension. https://store.extension.iastate.edu/product/15554 * denotes student co-author
  • Type: Journal Articles Status: Under Review Year Published: 2019 Citation: Peters, D., Monnat. S., Hochstetler, A., & Berg, M. The Opioid Hydra: Understanding Mortality Epidemics and Syndemics Across the Rural-Urban Continuum. Minor revisions June 2019, Rural Sociology. (JCR=1.87, SJR=1.98)