Michele Staton-Tindall

1. Michele Staton-Tindall, Ph.D., M.S.W.
University of Kentucky
College of Social Work
Center on Drug & Alcohol Research
Presented to the University of Kentucky Symposium on Drug Abuse, Obesity, and Diabetes in Appalachia
November 17, 2015

2.  This presentation is supported by the National Institute
on Drug Abuse (R01-DA033866).
 Recognize the cooperation and partnership with the
Kentucky Department of Corrections and jail
administrators and staff in the Laurel County Detention
Center, Leslie County Detention Center, and Kentucky
River Regional Jail.
 Recognize project Co-Investigators: Matt Webster, Carrie
Oser, Jennifer Havens, and Carl Leukefeld

3.  Describe UK study in Appalachia targeting screening and
brief intervention for substance use and high risk sexual
behavior among rural women.
 Profile drug use and related health risks of 400 rural
Appalachian women.
 Discuss clinical implications for identifying and targeting
services for at-risk and hard-to-reach substance users in
rural areas.

4.  Drug abuse, especially prescription opiates, is rampant in certain
rural areas of the country, particularly the Appalachian region.
 In recent years, the injection prevalence rate is higher among KY
samples of opiate users from Appalachia (44.3%) than reported
in other national studies1.
 The rise of injection drug use in Appalachia creates an
impending and significant public health concern.
 One group that may be particularly vulnerable to the negative
consequences of injection drug use including HIV and HCV is
women who engage in high-risk drug use and risky sexual
activities.
1Havens, Walker, & Leukefeld, 2007

5.  Funded by NIDA in July 2012

7.  Screening – NIDA Modified ASSIST (N=688)
Total Score Low Risk Mod risk High Risk
Rx Opioid 26.5 (sd=14.3) 14.8% 22.8% 62.4%
Sedatives/Sleep Pills 19.7 (sd=14.9) 26.5% 32.0% 41.6%
Methamphetamine 14.9 (sd=15.7) 44.0% 23.4% 32.6%
Marijuana 11.8 (sd=11.7) 36.1% 48.1% 15.8%
Street Opioid 10.0 (sd=14.7) 62.4% 16.3% 21.4%
Cocaine 8.9 (sd=12.2) 55.1% 31.1% 13.8%
Rx Stimulant 6.6 (sd=11.0) 65.3% 24.7% 10.0%

8.  Random selection
 Screening
 Baseline interviews (N=400)
 HIV/HCV testing
 Brief intervention
 Education (NIDA Standard)
 Education + Brief Motivational Interviewing for HIV Risk

9. Lindsey is a 26 year old white female from Perry County, KY. She is currently
in the Leslie County Jail for possession of a forged instrument, escape, and
contraband. She began experimenting with drugs at the age of 15
(marijuana and alcohol), however, she was a talented basketball player and
this limited her use to parties on weekends. Lindsey experimented with
prescription pain pills and became a heavy user during the last semester of
her senior year in high school, after basketball season was over. She reports
she has been in and out of jail since she graduated at the age of 18. Her drug
of choice is Oxycodone (previously OxyContin, currently Roxicodone 30’s).
She reports she has been using drugs via IV for 6 or 7 years.
Lindsey has a supportive mother and father, who has attempted to help her
get sober on numerous occasions. They have paid to send her to rehab five
times. Lindsey says she didn’t take the rehab serious and her parents have
given up on her ever changing. Lindsey’s 28 year old sister was also a drug
addict, but has maintained sobriety for two years. She now has a job and is
doing well. Lindsey appears jealous of her sister and seems annoyed that
she is sober.

10. Randomly selected
for screening
N=900
Screened Eligible
N=425
No drug use (n= 6)
No risky sex (n= 11)
Refusal (n= 105)
Baseline completed
N =400
Time frame (n=192)
Randomization
Intervention
Group
n = 199
Comparison
Group
n = 201
Released early
(n=150)
Not from area (n=11)
Not screened
(n=255)
Screened Ineligible
(n=220)
Released (n=23)
Refusal (n=2)
Baseline not
completed (n=25)

11.  Follow-ups are currently being conducted at 3, 6,
and 12 months post-release to examine changes in
injection drug use practices, other drug use, sex risk
behavior, and service utilization.
 Current follow-up rates
Wave Follow-up Percentage
3 month 88%
6 month 84%
12 month 86%

13. Percent/Mean
(SD)
SD, Range
Age 32.8 8.2, 18-61
Race - %white 99.0%
Average days spent incarcerated 70.2 87.7, 3-800
Ever had a driver’s license 75.8%
Current marital status – married 32.0%
Have any children 87.2%
Highest grade of education completed 11.1 2.3, 0-19
Working full or part time in past 6 months 22.8%
Had money problems in 6 months before jail 71.3%

15. Ever Used Used in Past Year
Opiates 97.8% 89.2%
Alcohol 96.8% 57.5%
Marijuana 95.8% 76.3%
Stimulants 88.5% 51.5%
Downers 86.8% 80.9%
Methamphetamine 74.3% 73.2%
Heroin 46.8% 61.5%

16. Average number of days using multiple
substances in one day in the past 6 months
132.3
(sd=70.3, range 0-180)
Average number of days in the past 6 months
being “high” on drugs
135.8
(sd=70.1, range 0-180)
Average number of days in the past 6 months
being “drunk” for most of the day
11.0
(sd=37.3, range 0-180)

17. Ever Injected Past 6 Months Past 30 Days
Any Drug 75.5% 78.2% 50.6%
• Prescription Pain Relievers 88.4% 68.5% 39.9%
• Prescription Stimulants 23.8% 39.4% 6.3%
• Prescription Benzodiazepines 31.9% 55.2% 10.8%
• Methamphetamine 66.2% 70.0% 29.4%
• Cocaine 53.0% 39.6% 12.3%
• Heroin 38.9% 48.7% 9.3%

18. Percent reporting lifetime history of…
Major or Untreated Dental Problems 34.8%
Convulsions, Migraines, or Nervous System Problems 34.3%
Allergies 34.0%
Heart, Blood or Circulatory Problems 23.3%
Asthma, Shortness of Breath, or Other Respiratory Problems 19.5%
Female Problems 17.5%
Bone, Muscle, or Foot Problems 15.0%
Stomach or Digestive System Problems 12.5%
Tumors, Cancer, or Unusual Lumps Under Skin 11.3%
Vitamin Deficiencies, Fluid Buildup, Anemia 10.3%
Diabetes, Thyroid Problems 9.3%
Physical Injuries or Unhealed Wounds 8.0%
Any Other Major Medical Problems 6.3%
Sexual or Fertility Problems 4.5%
Skin Problems 1.8%

19. Percent endorsing symptoms (GAIN) in past year
consistent with…
Major Depressive Disorder 68.5%
Posttraumatic Stress Disorder 67.4%
Generalized Anxiety Disorder 45.3%

20. Age first time had sex 14.8
(sd=2.05; range 6—22)
Average number of lifetime male sexual partners 33.0
(sd=49.77; range 2—500)
Average number of lifetime female sexual partners 3.5
(sd=9.85; range 0—500)
Ever had sex in exchange for $, drugs, etc. 43.5%
Always uses condom/protection with main partners 4.5%
Last main partner injected drugs 58.1%
Last male casual partner injected drugs 48.3%
Used drugs/alcohol before sex with main partner 83.2%
Used drugs/alcohol before sex with male casual partner 89.4%

21. Ever been told by a doctor/health care provider
that you were HIV positive?
0%
• Tested positive for HIV in the study 0%
Ever been told by a doctor/health care provider
that you were HCV positive?
26.3%
• Tested positive for HCV in the study 59.0%

23. 46.6%

24. Drug use impacts health, particularly increasing the risk for
HCV…
 Oh yeah, Hepatitis is just like a plague around here. 9 times
out of 10 around here you’ll have it around here.
 It’s not a big thing [laughter], “oh hey, I got Hep”. I don’t
mean that in a negative way toward the area around here,
it’s just that the IV drug use is so heavy around here. When
you have such common IV drug use, hepatitis just comes
with it.

26. Routine physical exam 17.4%
Routine eye exam 16.1%
Routine dental exam 28.8%
Pap Smear or women's health exam 25.6%
Mammogram 12.3%

27. Lifetime…
Ever been in substance treatment 49.8%
Ever sought mental health treatment 55.5%

28. 36.5%
79.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Study Enrollment
Before ACA (n=137) After ACA (n=82)***p<.000

29. B p
OR
(CI 95)
Age 0.05 .017
1.06
(1.01-1.10)
Income during 6 months prior to
incarceration
-.07 .018
0.94
(0.89-0.99)
Had money problems during 6 months
before incarceration
1.03 .008
2.81
(1.31-6.03)
Insured for at least 1 month during 3
month follow-up period
1.60 .000
4.94
(2.49-10.64)
# of days bothered by health problems
during 3 month follow-up
0.13 .014
1.14
(1.03-1.26)

30.  Rates of drug use, particularly prescription opioid use, are
alarmingly high in this area of Appalachia.
 Injection is the preferred route of administration, which is
coupled with increased public health risks including HCV and
HIV.
 Risky drug use is associated with a number of mental health
and health consequences, including HCV.
 Jails provide an important venue to identify, assess, and
intervene with high-risk rural women substance users who
may not access services.

31. Contact information:
Michele Staton-Tindall, Ph.D.
UK College of Social Work
UK Center on Drug & Alcohol Research
659 Patterson Office Tower
Lexington, KY 40508
Email: mstindall@uky.edu
Phone: 859-257-2483