Using Web-Based Pin-Drop Maps to Capture Activity Spaces Among Young Adults Who Use Drugs in Rural Areas: Cross-Sectional Survey

Abstract

BackgroundEpicenters of harmful drug use are expanding to US rural areas, with rural young adults bearing a disproportionate burden. A large body of work suggests that place characteristics (eg, spatial access to health services) shape vulnerability to drug-related harms among urban residents. Research on the role of place characteristics in shaping these harms among rural residents is nascent, as are methods of gathering place-based data.ObjectiveWe (1) analyzed whether young rural adults who used drugs answered self-administered Web-based mapping items about locations where they engaged in risk behaviors and (2) determined the precision of mapped locations.MethodsEligible individuals had to report recently using opioids to get high; be aged between 18 and 35 years; and live in the 5-county rural Appalachian Kentucky study area. We used targeted outreach and peer-referral methods to recruit participants. The survey asked participants to drop a pin in interactive maps to mark where they completed the survey, and where they had slept most; used drugs most; and had sex most in the past 6 months. Precision was assessed by (1) determining whether mapped locations were within 100 m of a structure and (2) calculating the Euclidean distance between the pin-drop home location and the street address where participants reported sleeping most often. Measures of central tendency and dispersion were calculated for all variables; distributions of missingness for mapping items and for the Euclidean distance variable were explored across participant characteristics.ResultsOf the 151 participants, 88.7% (134/151) completed all mapping items, and ≥92.1% (>139/151) dropped a pin at each of the 4 locations queried. Missingness did not vary across most participant characteristics, except that lower percentages of full-time workers and peer-recruited participants mapped some locations. Two-thirds of the pin-drop sex and drug use locations were less than 100 m from a structure, as were 92.1% (139/151) of pin-drop home locations. The median distance between the pin-drop and street-address home locations was 2.0 miles (25th percentile=0.8 miles; 75th percentile=5.5 miles); distances were shorter for high-school graduates, staff-recruited participants, and participants reporting no technical difficulties completing the survey.ConclusionsMissingness for mapping items was low and unlikely to introduce bias, given that it varied across few participant characteristics. Precision results were mixed. In a rural study area of 1378 square miles, most pin-drop home addresses were near a structure; it is unsurprising that fewer drug and sex locations were near structures because most participants reported engaging in these activities outside at times. The error in pin-drop home locations, however, might be too large for some purposes. We offer several recommendations to strengthen future research, including gathering metadata on the extent to which participants zoom in on each map and recruiting participants via trusted staff.

Willingness to Participate in At-Home HIV Testing Among Young Adults Who Use Opioids in Rural Appalachia

“…The final sample thus included 151 valid surveys. More details on fraud detection can be found elsewhere [36,39].…”

People, places, and stigma: A qualitative study exploring the overdose risk environment in rural Kentucky

“…Though the War on Drugs of the 1980s and 1990s was waged against urban communities of color as a mechanism to maintain racial/ethnic and class hierarchies in post-Jim Crow era (Weiss Riley et al, 2018), it has since travelled with the burgeoning opioid epidemic into predominately White, non-Hispanic rural areas, transforming these risk environments. National data reveal that rural counties are experiencing greater increases in arrest rates than their more urbanized counterparts; a study in these same five counties by Cooper et al (2019) found that 39.7% of PWUO or PWID had a history of arrest. In this qualitative sample, young adult PWUO -residents of rural counties where >95% of residents were non-Hispanic White -reported significant police activity and fear of arrest and incarceration.…”

Novel Recruitment Methods for Research Among Young Adults in Rural Areas Who Use Opioids: Cookouts, Coupons, and Community-Based Staff

“…Thereafter, staff members contacted participants suspected of fraud to inform them that their entry was flagged and to request they contact staff members to verify their entry to receive compensation, although none did. Staff members identified an additional 18 entries as fraudulent using strategies (described elsewhere 35 ) that were informed by a fraud-detection algorithm used previously in online research. 36 Staff members identified these entries after data collection had ended; as such, these participants were not contacted.…”

“…Demographic and behavioral characteristics of the final valid sample (n = 151) are described elsewhere. 35 Recruitment method yield and peer referral. We used SPSS version 25 (IBM Corp) to calculate descriptive statistics of the numbers of online screening survey entries, eligible entries, and complete and nonfraudulent eligible surveys for each recruitment method.…”