Author ORCID Identifier
Doctor of Philosophy
Traci Wike, PhD
The opioid epidemic has disproportionately affected rural communities with higher rates of misuse and opioid-related mortalities. Rural adolescents are particularly vulnerable to the epidemic, but research has scarcely considered how preventing adolescent opioid misuse can have a long-term impact on mitigating the epidemic. Opioid misuse prevention efforts in rural areas with fewer formal resources can leverage the role of the parent/caregiver to implement prevention in the home. Using a three-paper format, this dissertation examines the current state of opioid misuse prevention in rural areas in the United States and how rural parents/caregivers engage with opioid misuse prevention tools. This dissertation assesses individual and structural factors and their relationship to parent/caregiver prevention efforts.
Paper one is a systematic review of rural opioid misuse prevention efforts. In this paper, I present findings from the current literature that has explored universal, selective, and indicated prevention levels with consideration for rurality. These findings are categorized into micro and macro levels of ecology. This review found the majority of research has been conducted on selective and indicated prevention levels which focus on overdose and relapse prevention, despite the cost-efficiency and widespread benefit of universal prevention efforts which focus on prevention of initial onset of misuse.
Papers two and three used cross-sectional primary survey data to examine the awareness and utilization of universal opioid misuse prevention efforts by rural parents/caregivers. In paper two, I examined individual factors, specifically prescription misuse experiences and parenting self-efficacy, and their relationship to parent/caregiver awareness and utilization of opioid misuse prevention tools. Findings show parents/caregivers’ own prescription misuse experiences and those of their close friends were positively and significantly related to parents/caregivers’ awareness of opioid misuse prevention tools. Prescription misuse experiences, awareness of opioid misuse prevention tools, and parenting self-efficacy were not significantly linked to the parent/caregiver’s utilization of opioid misuse prevention tools. In paper three, I examined structural elements of the rural environment (informal social control, trust/cohesion, perceived disadvantage, and community networks), their direct effects on parent/caregiver utilization of opioid misuse prevention tools, and the indirect effect of the parent/caregiver’s opioid misuse health beliefs on the relationship between the environment and utilization. This study found informal social control to be directly linked to utilization of opioid misuse prevention tools. Trust/cohesion, perceived disadvantage, and community networks were directly linked to opioid misuse health beliefs but not to the utilization of opioid misuse prevention tools.
Drawing on social cognitive theory, social disorganization theory, and the health belief model, this dissertation provides an examination into rural opioid misuse prevention and how parents/caregivers are knowledgeable of and engaging with universal tools to prevent their adolescent’s onset of opioid misuse. This dissertation assesses individual and structural factors and how they motivate or hinder parent/caregiver awareness and utilization of opioid misuse prevention tools. Findings urge further consideration of the role of the rural social and structural environment in developing and promoting effective opioid misuse prevention efforts in rural communities.
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Available for download on Friday, May 07, 2027