Social Epidemiological Mediators of Rural and Urban Differences in Perceived Need for Cocaine Use Treatment

Rural/urban disparities in cocaine use treatment are commonly attributed to variations in social epidemiological constructs, such as socioeconomic status and well-being, social capital and support, and discrimination, as well as health care attitudes and health beliefs. This study examined whether these factors mediate rural versus urban disparities in perceived need for cocaine use treatment, a concept closely linked to treatment utilization. Data were collected from 200 rural and 200 urban African American/Black persons who were active cocaine users and not in treatment. A multiple mediation model using path analysis was estimated to determine whether Addiction Severity Index (ASI) employment and legal scores, community trust, social support, rejection/discrimination, religious coping, medical skepticism, perceived treatment privacy and effectiveness, and Patient Health Questionnaire-9 (PHQ-9) depression scores were mediators of the association between rural/urban residence and perceived treatment need. The total indirect effect of the multiple mediators was significant (unstandardized bootstrapped estimate of 0.444 and 95% CI of [0.11, 0.81]). Unstandardized bootstrapped estimates for individual significant (p < .05) mediators were as follows: ASI employment scores (−0.114), ASI legal scores (0.146), perceived treatment effectiveness (0.294), and Patient Health Questionnaire-9 scores (0.113). To further reduce rural and urban disparities in perceived need for treatment, policymakers, treatment managers, and providers might consider programs that address cocaine users' underlying social epidemiological differences. Public Health Significance Statement Few persons using illicit drugs ever receive formal treatment, and access is especially problematic for many rural residents. This article provides information about social, economic, and health-related factors that help to explain rural versus urban differences in perceived need for treatment, which has been shown in prior work to be a strong predictor of treatment utilization. The article's findings could be applied by practitioners and policymakers to further encourage thinking about accessing treatment among rural drug users.