Risk and Protective Factors for Rural Methamphetamine Dependence

Methamphetamine (meth) is second only to alcohol as the primary drug of abuse in persons
entering substance use disorders (SUD) treatment in rural Nebraska 1 . The National Survey on
Drug Use and Health 2002-2005 (NSDUH) found meth use increased as the setting became more
rural 2 . In a previous study comparing rural and urban persons with meth use disorders
(MUD), we found significant differences, with rural persons reporting earlier first regular
use of meth, greater meth-related psychotic symptoms, more alcoholism, and more intravenous
(IV) use 3 . No studies have compared frequency of other behavioral risk factors in rural and
urban meth users. Similarly, no studies have compared risk factors for methamphetamine
dependence in this uniquely rural drug use disorder. It is critical that other high risk
behaviors (in addition to IV use) be identified in rural persons with MUD and that risk
factors for MUD be identified as a crucial first step in providing resources to tailor
prevention efforts in rural populations.

In addition to the need for further research on risk factors, scholars have called for more
studies on protective factors to develop more effective intervention programs 4 . Researchers
have identified factors that mitigate negative outcomes among individuals at high risk. In
general, active coping and high levels of social support and empathy have been linked to
better health outcomes whereas avoidance coping and low levels of social support and empathy
have been associated with worse health outcomes 4, 5 . However, no factors have been
identified in rural meth users which are protective for worse health outcomes.

Meth distribution has been linked to "Mexican Drug Trafficking Organizations" and "Hispanic
polydrug trafficking organizations" 6, 7 , but there is little research examining meth use in
Latinos. In a previous study of Hispanic and non-Hispanic white individuals with MUD,
Hispanics reported less education and more employment problems, 8 but the study did not
address rural MUD. This proposed study of rural and urban Latinos with meth dependence will
provide initial data to begin to inform prevention efforts targeting rural Latinos with MUD
and may be useful in rural Latinos with other SUD.

Our interdisciplinary investigative team proposes to address the following Specific Aims over
a two-year period: 1) compare socio-demographic, bio-psychosocial and behavioral risk and
protective factors between rural and urban persons with methamphetamine dependence (Year
One); 2) identify factors that place persons with methamphetamine dependence at risk for
greater psychopathology and identify factors that mitigate those persons from psychopathology
(Year One); 3) compare severity of methamphetamine dependence between Latino and non-Latino
populations and urban and rural Latino populations (Year Two). Our hypothesis is that rural
persons with methamphetamine dependence will have greater socio-demographic, bio-psychosocial
and behavioral risk factors than their urban counterparts.

The targeted populations will be adults with methamphetamine dependence. We will enroll 150
individuals (75 rural and 75 urban) 75 of whom will be Latinos from substance abuse treatment
sites. Data analyses will focus on comparing MUD across urban/rural and Latinos/non-Latinos.
Thus, this study will identify factors which may place rural, urban, Latino, and non-Latino
persons with MUD at greater risk for, or protect them from, psychopathology, infectious
complications, and poorer treatment outcome. The long-term goals of this study are to: a)
provide data that will strengthen a re-submission to the National Institute on Drug Abuse
(Behavioral and Social Science Research on Understanding and Reducing Health Disparities,
PAR-07-379 ); b) establish relationships with providers of substance abuse treatment to
Latinos facilitating enrollment of Latinos in future research studies; and c) identify
specific factors that can be incorporated into prevention strategies in underserved
populations (e.g. Latinos, rural populations).

Inclusion Criteria:

- Adults in SUD treatment facilities meeting DSM-IV criteria for methamphetamine
dependence and able to provide informed consent.

- We intend to oversample Latinos in order to achieve a group with sufficient power to
compare to non-Latinos. Our goal is to recruit 75 Latinos and 75 non-Latinos.

Exclusion Criteria:

- Persons not meeting the DSM-IV criteria for methamphetamine dependence and persons
unable to complete informed consent.