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Using Network and Spatial Data to Better Target Overdose Prevention Strategies in Rural Appalachia

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Abstract

This analysis uses network and spatial data to identify optimal individuals to target with overdose prevention interventions in rural Appalachia. Five hundred and three rural persons who use drugs were recruited to participate in the Social Networks among Appalachian People Study (2008–2010). Interviewer-administered surveys collected information on demographic characteristics, risk behaviors (including overdose history), network members, and residential addresses. We restricted the sample to individuals with at least one confirmed relationship to another study participant (N = 463). Using dyadic analyses (N = 1428 relationships), we identified relationship-level correlates of relationships with network members who have previously overdosed. We then examined individual- and network-level factors associated with (1) having at least one first-degree alter (i.e., network member) with a prior overdose and (2) each additional network member with a prior overdose (N = 463 study participants). Overall, 28% of the sample had previously overdosed and 57% were one-degree away from someone who previously overdosed. Relationships with those who had overdosed were characterized by closer residential proximity. Those with at least one network member who previously overdosed were more geographically central and occupied more central network positions. Further, the number of network members with an overdose history increased with decreasing distance to the town center, increasing network centrality, and prior enrollment in an alcohol detox program. Because fatal overdoses can be prevented through bystander intervention, these findings suggest that strategies that target more central individuals (both geographically and based on their network positions) and those who have previously enrolled in alcohol detox programs with overdose prevention training and naloxone may optimize intervention reach and have the potential to curb overdose fatalities in this region.

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Acknowledgements

Funding was provided by the National Institute of Health grant numbers R01 DA024598 & R01 DA033862 (PI: Havens, JR), K01 DA033879 (PI: Rudolph, AE), and R21 AI131979 (PI: Rudolph, AE).

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Authors and Affiliations

  1. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

    Abby E. Rudolph

  2. Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA, 19122, USA

    Abby E. Rudolph

  3. Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA

    April M. Young

  4. Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA

    April M. Young & Jennifer R. Havens

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  1. Abby E. Rudolph
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  2. April M. Young
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Correspondence to Abby E. Rudolph.

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Rudolph, A.E., Young, A.M. & Havens, J.R. Using Network and Spatial Data to Better Target Overdose Prevention Strategies in Rural Appalachia. J Urban Health 96, 27–37 (2019). https://doi.org/10.1007/s11524-018-00328-y

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