Patterns of Felt Stigma Among Rural-Dwelling People Who Use Drugs: A Latent Class Analysis

Area of Science:

• Public Health
• Sociology
• Psychology

Background:

• Stigma acts as a significant barrier to healthcare access for rural populations with substance use disorders.
• Limited research exists on the specific patterns of stigma experienced by people who use drugs in rural settings and associated factors.

Purpose of the Study:

• To identify distinct patterns of felt substance use stigma among people who use drugs in rural areas.
• To investigate demographic, health, and substance-related characteristics associated with different stigma profiles.

Main Methods:

• Latent class analysis was employed to classify 3048 participants from eight Rural Opioid Initiative sites based on felt stigma.
• Multinomial logistic regression was used to identify covariates linked to class membership.

Main Results:

• A five-class solution was identified, with four classes reflecting varying levels of perceived stigma (Low to High).
• A distinct fifth class ('High Fearers/Low Perceivers') exhibited high internalized shame and fear but low perceived stigma.
• Higher stigma classes were associated with criminal-legal involvement, injection drug use, and avoidance of healthcare and treatment.

Conclusions:

• Substance use stigma manifests in discernible, severity-based patterns among rural individuals who use drugs.
• A unique class with high internalized stigma suggests potential non-disclosure of substance use.
• These identified profiles and their correlates provide a foundation for developing tailored interventions to mitigate stigma.