'Forensic nursing' idea of online Frontier Nursing University student could help victims of domestic violence in rural areas

Unseen and unspoken, rural victims of domestic violence are more likely to suffer alone because of geographical isolation, lack of medical support networks, and an "everybody knows everybody" small-town culture that can keep victims from asking for help.

Leslie Copp (Photo from The Daily Yonder)

With the help of a Tillman Foundation scholarship, Leslie Copp, a nurse who grew up in a home with domestic violence, aims to change some of that in rural Indiana, reports Liz Carey of The Daily Yonder. "Copp is an online graduate student at Frontier Nursing University, located in Versailles. Her nursing work includes caring for trauma victims and gathering evidence for prosecutors. She wants her graduate education to help her specialize in trauma care and establish trauma care centers in rural communities like her hometown of Odon, Indiana, pop. 1,400."

Forensic nursing is an emerging field that many students may not know exists. Copp began her medical career as a Certified Nurse Assistant, then earned a bachelor's degree in nursing, but along the way, "realized she enjoyed taking care of trauma victims and helping as a forensic nurse to collect evidence to assist in prosecuting abuse cases. She said she feels born to work as a forensic nurse examiner." She told Carey: "I was raised at the very first of my life in a home where I dealt with watching my mother go through domestic violence. I didn't realize that the trauma that I had been through as a young adult would set the base for something that I would grow to love. I turned my trauma into something that I could do to help others." Carey reports, "She intends to pursue a doctorate in nursing practice and to become a mental health nurse practitioner."

Copp told Carey: "In Indiana alone, there are wide areas where there are no resources or care for victims of trauma or violence. My goal is to start with one (rural trauma care center) and plant it in a place that has the widest area of no coverage so that we can at least start providing medical exams (for trauma victims) and point people in the right direction." Part of the dilemma in gathering prosecutorial evidence from victims is timing and victim bandwidth for the process, Carey writes. By the time a victim is treated at their local hospital, they don't have the energy to go to a metro hospital for another work-up. "Even if a nurse sees them in a metropolitan area, the patients get lost in the system without access to resources like trauma therapy, advocacy services, and support systems."

Frontier Nursing University Assistant Professor Dr. Joshua Faucett told Carey, "Copp's experience as a nurse and violence survivor made her a good candidate for the scholarship. . . . Leslie is a sexual assault nurse examiner and has testified on behalf of sexual assault victims to bring their abusers to justice." Carey adds, "Copp's goal is to create a trauma center in a rural area that could both do medical exams and help victims gain access to social workers, prosecutors, and emergency housing."

As nation sees a surge in cases from Omicron variant, Kentucky's new-case rate falls more than any other state's in last 2 weeks

By Al Cross

Kentucky Health News

As the United States sees the highest number of new cases of the coronavirus since the surge in late summer, Kentucky is an outlier.

In the last two weeks, the nation has averaged more than 200,000 new cases per day, a 69 percent jump during the period, but Kentucky's new-case rate has dropped 39%, more than any other state, according to The New York Times.

Kentucky's new-case rate over the last seven days ranks 39th among the states, the Times reports. Citing Centers for Disease Control and Prevention data, the newspaper says Kentucky's new-case average over the last seven days is 1,383 per day. That's 39% lower than the 2,270 average calculated from the state's last public report on Dec. 22, four days before the Times report.

The difference could be driven by more limited testing and reporting in Kentucky over the Christmas holidays, and maybe by geography. The states with low new-case rates tend to have large rural populations and lie in the interior of the country, while most of the states with big increases are along the coasts.

Examples include Florida, 818%; Georgia, 299%; and Louisiana, 243%. Virginia's rate has risen 106% and California's has gone up 90%. One other state that borders Kentucky is above the 69% national increase: Illinois, at 75%. Other gains among bordering states are Ohio, 61%; Tennessee, 57%; and West Virginia, 12%. Indiana is down 8% and Missouri is down 3%.

Kentucky officials will resume their daily release of coronavirus data on Monday, but the more telling day is likely to be Tuesday, reflecting testing, reporting and hospitalizations on the first day after the holidays.

Gov. Andy Beshear has said the state will see a surge in cases from the highly contagious Omicron variant of the virus, which could be limited if more Kentuckians would get vaccinated against the virus or get a booster shot. Medical experts say vaccinated people without boosters are not well protected against Omicron.

Only 33.6% of the state's "fully vaccinated" residents have received a booster, according to CDC data compiled by The Washington Post; it says 57.4% of Kentucky's vaccine-eligible population, 5 and older, and 54% of the entire population, are fully vaccinated, a term that does not include booster shots.

Because vaccination rates are higher in more populous counties, only 14 of the 120 counties are above the statewide 54%-of-population figure: Fayette and Woodford, 63%; Jefferson, 61%; Campbell, 60%; Boone and Perry, 59%; Franklin, 58%; Hardin and Kenton, 57%; Hancock and Lyon, 56%; and Floyd, Fulton and Oldham, 55%.

Rural Americans are the most likely to say the pandemic is over, and least likely to take precautions against it

The Atlantic/Leger poll was conducted Nov. 5-7. Click the image to enlarge or click here for the rest of the report.

Though the coronavirus remains entrenched in rural areas, rural Americans are more likely than their suburban or urban peers to have rejected or given up on social distancing, masking and/or vaccinations. "They feel, in short, that the pandemic is 'over,'" Olga Khazan reports for The Atlantic. According to a recent Atlantic/Leger poll, "people in rural areas are most likely to feel like things are 'back to normal' where they live—45 percent thought so, compared with 30 percent of urbanites and 36 percent of suburbanites. Rural Americans were also the least likely group to say they wished their neighbors would be more cautious about Covid-19."

Rural Americans were less likely than suburban or urban residents to say most adults they know are vaccinated against the coronavirus, and more likely to say they socialize indoors with unmasked friends, Khazan reports. State and community laws were more likely to foster rural Americans' attitudes: Only 27% of rural residents said they have to wear a mask to work, and rural schools and daycares were less likely to require kids to wear masks or require kids to stay home if they have Covid-19 symptoms.

"For a lot of people who aren’t wearing masks or getting vaccinated, they think that this has just been blown out of proportion, and that people are just too fearful and need to go about their lives," Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials, told Khazan.

"Among the rural unvaccinated, this is a false sense of security. Covid is spreading rapidly in rural areas, which is worrisome because rural people tend to be older, poorer, and in worse health to begin with," Khazan reports. "If they do get sick, they have less access to hospitals—more than 100 rural hospitals have closed since 2013. The Covid-19 death rate in rural America is now twice the death rate in urban areas. And the longer that pockets of unvaccinated Americans remain, the greater the likelihood that new variants will take hold and spread elsewhere."

But, Khazan notes, policy makers may not have tried hard enough to understand rural Americans' viewpoints on the pandemic. And it's difficult for many rural counties to get accurate information, especially since many lack health departments and good local newspapers, she writes: "Of course they feel abandoned, and at this point, defiant."

'Unplug' from sources of misinformation, and treat unvaccinated with dignity and respect, Ky. health chief tells rural health leaders

By Melissa Patrick
Kentucky Health News

If you're trying to persuade someone to get a Covid-19 vaccine, it's important to come from a place of "mutual regard and respect," state Health Commissioner Steven Stack told members of the Kentucky Rural Health Association at its annual conference Monday.

Misinformation is a big obstacle to vaccination, and Stack told the online meeting that the most important thing we can do to stop the spread of misinformation is to "unplug" from social media and make sure you are getting your information from a credible news source, and not an entertainer. 

Commissioner Steven Stack, M.D.

Stack, a physician, stressed that it doesn't matter whether a person lives in rural Appalachia or in urban Jefferson County, people don't like to have their community values and believes treated with disregard. An added challenge, he said, is that getting more Kentuckians vaccinated requires more than  presenting "just the science."

"If we don't find a way to meet folks in a place where they feel respected and treated with dignity and regard, it just feels like someone from a distance is lecturing to them and telling them what they must do -- and that doesn't work," he said. 

Further, he said the messenger needs to come from a trusted source in the community, and delivering the message may involve a two-step process: first, a safe space to normalize the vaccine and answer questions about it, followed by opportunities to get it.

Stack also said it's important to remember that people have many reasons for not getting vaccinated that go beyond their personal beliefs and ideology, including a lack of transportation, poor health literacy, or misinformation. 

"Misinformation literally is a killer," he said. "What people see on Facebook and TikTok and Instagram and Twitter, that stuff literally has killed people, because there's all these falsehoods that have been spread."

He said we must all have empathy for any young woman of childbearing years who chooses not to get a vaccine because of the misinformation she's being fed that it could cause infertility, "when there is no evidence that that's the case whatsoever." 

"We've got to find a way to overcome that," he said. 

It's easy to get locked into an echo chamber and to hear only what a person likes to hear, Stack said, recommending that everyone needs to "unplug" from social media more often and to treat all of it as "a treat" instead of a staple. He also encouraged people to be more selective about where they get their news. 

"And by the grace of God, none of us should be watching anything on cable television that purports to be news that is really entertainment," he said. 

The latest Kaiser Family Foundation Covid-19 Vaccine Monitor poll that looked at media and misinformation found that belief in pandemic-related misinformation is widespread, with 78% of adults saying they have heard at least one of eight different false statements about Covid-19 and that they believe it to be true or are unsure if it is true or false. One-third (32%) of all adults believe or are uncertain about at least four false statements. 

The eight common falsehoods asked about in the poll included: the government is exaggerating the number of Covid-19 deaths; pregnant women should not get a vaccine; deaths due to vaccines are being intentionally hidden by the government; the vaccines have been shown to cause infertility; Ivermectin is a safe and effective treatment for Covid-19; you can get Covid-19 from a vaccine; the vaccines contain a microchip; and they can change your DNA. All those statements are false.

A Kaiser news release said, "Belief in Covid-19 misinformation is correlated with both vaccination status and partisanship, with unvaccinated adults and Republicans much more likely to believe or be unsure about false statements compared to vaccinated adults and Democrats."

Kaiser Family Foundation graph; click on it to enlarge.

The poll, taken Oct. 14-24, also found that a person's trusted news source correlated with their belief in Covid-19 misinformation.

The survey found that respondents were less likely to believe any of the eight pieces of misinformation if they said their trusted news source for Covid-19 information was CNN, MSNBC, network news, NPR or local TV news.

The poll found that misinformation was more likely to be believed by those who said their trusted Covid-19 information came from conservative news sources, "with nearly four in 10 of those who trust Fox News (36%) and One America News (37%) and nearly half (46%) of those who trust Newsmax for such information saying they have heard at least four of the falsehoods tested in the survey and either believe them to be true or are unsure if they’re true or false."

That finding doesn't prove that those sources convey misinformation, because it could also be that the types of people who choose those sources are likely to believe certain types of misinformation, the release said. 

Stack told the rural health conferees that overall pandemic trends in Kentucky are heading "in the right direction," but expressed concern that cold weather and an increase in indoor social events during the holiday season could lead to another rise in cases, especially in rural areas with low vaccination rates.

"It raises the real concern that we could have yet another escalation. . . . Folks clearly are not in the same level of compliance with mask use and physical distancing that we were last year, and that will all be a recipe for an increase," he said.

Most of Kentucky's 120 counties have less than one-half of their populations vaccinated with at least one dose of a vaccine, according to the federal Centers for Disease Control and Prevention.

State Dept. for Public Health map, adapted by Ky. Health News; click on it to enlarge. Interactive at
https://dashboard.chfs.ky.gov/views/KYPublicFacingDashboard_16191000580170/KentuckyCOVID-19Vaccination

UK physician Peterson will be co-presenter in Nov. 9 webinar about the critical role of family physicians in rural America

Lars Peterson, M.D., Ph.D.

A University of Kentucky physician and a University of Washington researcher will hold a webinar at 1 p.m. Tuesday, Nov. 9 to discuss the critical role of family physicians in rural America, how they're trained, their rural distribution, and differences in scope of practice in rural vs. urban family doctors.

The webinar will last about an hour. It's free, but registration is required. Click here for more information about the webinar and to register.

Lars Peterson and Davis Patterson will present the webinar. Peterson is a family physician and health services researcher, vice president of research of the American Board of Family Medicine, an associate professor of family and community medicine at UK and a faculty member at its Rural & Underserved Health Research Center. His major research focuses on how continuing education can improve quality of care. 

Patterson is a sociologist, research associate professor of family medicine and director of the Rural Health Research Center and the Collaborative for Rural Primary Care Research, Education, and Practice, and an investigator in the UW Center for Health Workforce Studies. His research focuses on improving rural health-care access and examining trends in rural workforce supply.

Study finds rural seniors less likely than urban ones to follow Covid-19 prevention advice, especially social distancing

Rural adults 65 and older were less compliant than their urban peers when it came to following some of the suggested strategies to slow the spread of the coronavirus, especially social distancing.

So says a recent study published in The Journal of Rural Health, which looked at whether "community dwelling" seniors (those not living in assisted living, nursing homes or other congregate settings) had adopted preventive measures recommended by the Centers for Disease Control and Prevention to slow the spread of the virus.

Following the CDC's advice is especially important for seniors because they have a higher risk of dying from Covid-19 if they get it. 

In Kentucky, 91.4% of all Covid-related deaths were in people 60 and older. And in December, WFPL reported that per-capita cases and deaths were higher in Kentucky's rural counties than its urban ones. 

The study researchers used self-reported data from the National Health and Aging Trends Study, conducted from June to October 2020, which asked about eight different risk-mitigation behaviors. The survey included nearly 3,000 community-dwelling urban and rural seniors.  

The researchers found that seniors' compliance with each of the eight behaviors to limit the spread of Covid-19 was high, but rural seniors were less likely to report compliance on five: social distancing, limiting gatherings, avoiding restaurants and bars, not touching their faces, and avoiding contact with those outside their households. 

However, after the data were adjusted for demographic characteristics, only maintaining a six-foot distance remained lower among rural seniors to a statistically significant degree. There were no rural-urban differences when it came to mask wearing, handwashing and limiting shopping.

Still, the researchers said their findings suggested the need for rural-specific messaging when it comes to such public-health emergencies.

Chamber, UK school starting public-policy series with discussion of health differences and disparities between rural and urban Ky.

The health disparities between rural and urban Kentucky, and differences in health-care access and delivery, will be discussed in the first of a new series of public-policy webinars sponsored by the Kentucky Chamber of Commerce and the Martin School of Public Policy & Administration at the University of Kentucky.

The sponsors say the event, scheduled from noon to 1:30 p.m. ET Tuesday, June 8, will examine the intersection of health care and the urban-rural divide: How do health care systems differ between Kentucky’s urban and rural areas and what makes these differences significant? Does public policy in Kentucky accurately reflect the diverse health care needs of our urban and rural populations? How does the urban-rural divide impact access to health care in Kentucky? Answers will come from a panel:

• Mark Birdwhistell, UK Health Care chief of staff and vice president for health services administration
• Larry Gray, president of Baptist Health Louisville and former president of Baptist Health Corbin
• State Sen. Ralph Alvarado, R-Winchester, chair of the Senate Health and Welfare Committee and a physician
• State Rep. Kim Moser, R-Taylor Mill, chair of the House Health and Family Services Committee and a former nurse

Chamber Senior Policy Analyst Charles Aull will moderate the discussion. He said it will include the opportunity for questions from participants. The webinar is free; to register, click here.

“We look forward to not only engaging in these roundtable discussions but also serving as a resource for policy-makers and other interested parties,” said Kate Shanks, vice president of public affairs at the Chamber and a Martin School graduate. “Our goal is that these sessions will lead to better understanding of these important issues and help develop Kentucky-specific solutions.”

Future programs in the series will address the rural-urban divides in education (July 15) and economic development (Aug. 10).

Kentucky put 32% fewer coronavirus shots into arms in the last vaccine-reporting week, as supply continued to outstrip demand

State table, updated by Kentucky Health News, shows how vaccine supply has exceeded demand.

By Melissa Patrick
Kentucky Health News

As delivery of coronavirus vaccines plummeted by almost a third in the past week, Gov. Andy Beshear continued to urge Kentuckians to get vaccinated so the state can get back to normal.

Beshear didn't have a news briefing Tuesday, but issued a press release emphasizing vaccinations over virus cases, which remained on a plateau.

“As our case numbers seem to be plateauing, it’s more important than ever for us to make sure our vaccination numbers are rising consistently,” he said. “Let’s meet our 2.5 million vaccine Team Kentucky Vaccination Challenge so we can get back to more of the activities we enjoy and keep ourselves, our families and our communities safe.”

Beshear has said he will open all businesses and activities to full capacity once 2.5 million Kentuckians have received a dose of vaccine. According to his press release, at least 1,672,364 Kentuckians have done so, which means about 827,000 more need to get vaccinated to reach that goal. 

But in the last Tuesday-to-Monday reporting week, only 84,968 Kentuckians got vaccinated, down from about 125,000 each of the two weeks before that, according to the state's vaccine report. That's a drop of about 32%.

The line for that week has an asterisk, which signifies that the state stopped administering the Johnson & Johnson vaccine on the advice of federal officials because one in a million people who got it had an unusual type of blood clot. The vaccine has only accounted for about 5% of the doses administered in Kentucky, but is in more demand because it requires only one dose.

At the current rate of vaccination, following Beshear's plan, the state wouldn't reopen until June 8, the Lexington Herald-Leader reports.

Beshear has asked vaccine sites to use at least 90% of their vaccine each week. Statewide, that goal hasn't been met for more than a month. Vaccine weeks run Tuesday to Monday because the state gets its supplies on Tuesdays. The state used 58% of its supply in the vaccine week beginning March 30; 45% the week beginning April 6 and 54% the week beginning March 13. 

Supply has clearly outstripped demand. Yesterday, Beshear said the state had about 400,000 doses available, and that was before the 150,000 doses that were expected to arrive today. Kentuckians can visit vaccinemap.ky.gov to find a vaccination site near where they live.

Polls have indicated that white, rural Republicans are less likely to get the vaccine, but another demographic factor appears to be in play. An NPR analysis of vaccinations of people 65 and older shows that Kentucky is lagging in the number of rural seniors getting shots; urban seniors' vaccination rate is 6.4 percentage points more than that of rural seniors.

NPR graph, adapted by Kentucky Health News; for a larger version, click on it.

Daily numbers: Beshear reported 609 new cases on Tuesday, bringing the state's seven-day rolling average down to 576, returning it to the levels seen around a week ago. 

The share of Kentuckians testing positive for the virus is 3.44%, down .02% from Monday and about the same as it's been for the last six days.

The state's daily average of new cases over the last seven days dropped to 11.71 per 100,000 residents, a drop of .43 from Monday.  The New York Times ranks Kentucky's rate 34th among the states. 

Counties with double the statewide rate were Bracken, 68.8; Lewis, 46.3; Mason, 41; Bath, 38.9; Powell, 34.7; Harlan, 32.4; Morgan, 32.2; Wolfe, 29.9; Logan ,27.4; Robertson, 27.1; Bell, 23.6; and Henderson, 23.4.

The state added 13 more Covid-19 deaths to its list of fatalities, seven from regular health-department reports and six from the ongoing audits of death certificates. That brings the total to 6,360. Over the last two weeks, the regularly reported deaths have averaged 7.7 per day. 

The regularly reported deaths were a Clay County man, 65; a Daviess County man, 77; a Meade County man, 82; a Pulaski County man, 88; two Rowan County women, 70, 82; and a Rowan County man, 83. The audit deaths were a Floyd County man, 83; a Hardin County woman, 65; a Jefferson County man, 73; a Larue County woman, 86; a Lewis County man, 85; and a McLean County woman, 83. 

Kentucky hospitals reported 419 Covid-19 patients (up 17 from Monday); 121 in intensive care (no change); and 48 of them on a ventilator (up 5). 

The Lake Cumberland hospital-readiness region continues to be the only one using at least 80% of its intensive-care beds, at 84%. 

Counties with 10 or more new cases were Jefferson, 80; Fayette, 44; Warren, 29; Christian, 22; Hardin, 19; Kenton, 17; Harlan, 16; Boone and Pike, 15; Campbell, 13; Daviess and Madison, 12; Henderson, 11; and Scott, 10. 

In long-term care, one more resident and four more staff members have tested positive for the virus, bringing the number of active cases to 46 residents and 84 staff.

Poll: 29% of Ky. adults said they probably or definitely wouldn't get a coronavirus shot, but half of them said they might reconsider

For a slightly larger version of the graph, click on it.

By Melissa Patrick
Kentucky Health News

About 30 percent of Kentucky adults said in late winter that they probably or definitely wouldn't take the coronavirus vaccine, but half of those people said they would be open to changing their mind if given more time and information, according to a poll taken for the Foundation for a Healthy Kentucky.

The poll, among Kentucky adults Feb. 11 to March 12, was taken to learn more about Kentuckians' opinions on coronavirus vaccines and about their intentions to take one or not. At the time, Kentucky was only vaccinating people over 60 and some others such as health-care workers and first responders. 

Now, anyone 16 and older can get a shot, and more than 1.6 million Kentuckians have received at least one dose of a vaccine. That's about 50% of Kentucky adults, Foundation CEO Ben Chandler said.

The poll found that 19% said they would definitely not get a vaccination and 10% said they would probably not. Those groups were asked, "Once more people in the U.S. start receiving vaccines for the coronavirus and there is more information about it , would you say it is possible you would decide to get a vaccine, or you are pretty certain that you would decide not to get a vaccine?"

Just over half, 51%, said they would. In reporting the results of this question, the foundation and the Institute for Policy Research at the University of Cincinnati, which conducted the poll, combined the "probably not" and "definitely not" groups and did not provide results for each group.

Chandler called the result good news and said it is key to Kentucky's chances of reaching herd immunity, which will provide some protection for people unwilling or unable to get a coronavirus vaccine. "We need these folks in order to get there," he said in a teleconference.  

The foundation's poll is consistent with national polls that have also found Republicans, men and rural residents are more reluctant than other groups to take a coronavirus vaccine.

The combined "probably not" and "definitely not" group in the Kentucky poll was more likely to be male, Republican, and to live in suburban or rural communities.

Among those who said they were willing to change their minds, 47% were Republicans, 50% were suburban, 53% were rural, and 53% were high-school graduates.

The less formal education a person had, the more likely they were to say that they would definitely or probably not get a vaccination.

On the other side of the coin, 76% of women, 87% of Democrats, 70% of independents, 80% of those living in urban areas and 81% of college graduates said they had already taken a vaccine or intended to.

The poll found that 71% of Kentucky adults had already been vaccinated or planned on getting a vaccine. Chandler said if all of them follows through, would get us "right at the edge of what we need to achieve herd immunity here in Kentucky," with 70% to 85% of the population vaccinated.

Chandler also spoke about the importance of reaching herd immunity before the virus mutates to the point that the vaccine is no longer effective. 

"If this virus mutates and is allowed to continue to produce these variants, at some point, there's a tremendous concern that the variants may outpace the vaccine and inhibit the efficacy of the vaccine," he said

For a larger version of this graph, click on it.

Looking at motivation, the survey found Kentucky adults were evenly split on whether getting a coronavirus vaccine is a personal choice or is part of everyone's responsibility to protect the health of the community. 

Those who saw it as a personal choice were more likely to lack a high-school graduation, identify as Republican or independents, and live in rural communities. 

Democrats, the college-educated and people in urban communities were more likely to see getting the vaccine as a community responsibility.

"This data will inform how we reach out to people to encourage more Kentuckians to roll up their leaves and get vaccinated," Chandler said. 

Chandler and Allison Adams, vice-president for policy at the foundation, said the final push to get Kentuckians vaccinated will depend on what happens at the local level and that the information found in this poll can help local communities target their messaging. 

“How do we dig deeper into finding those trusted community messengers?” Adams asked. “We know that there are social influences in all 120 counties of Kentucky. So, how do we continue to launch this public campaign of recruiting folks to receive the vaccine?”

Chandler said, "We're going to have to dig this out, I think, at the local level. We're going to continue to have to involve local public-health officials and leaders throughout the communities. We're going to have to point people throughout the state to the people that they see as trusted messengers -- and not just the message, but the messenger. "

He said those include faith leaders, local public-health officials, vaccine skeptics' primary-care providers, and residents of the community who have gotten the vaccine and have some faith among skeptics. 

"We've got to encourage those people to speak out about this to their local communities," he said. "It's not going to be enough, frankly, for the government to just sit there and tell them that they need to get the vaccine, because of the distrust. You've got to engage and employ other folks in the community and employ them in a major way in my judgment." 

Asked why Republicans, rural people and the less educated are more likely to say they will not get a vaccine and are more motivated by personal choice than community responsibility, Chandler said much of that has to do with where they get their information about the vaccines.

“I think a lot of it has to do frankly with the messages that they received,” Chandler said. “We have a very splintered media environment now in this country and different groups of people -- and this has been well-documented -- different groups of people get different media from different sources.” 

Further, Chandler said there are groups that oppose vaccination and elected leaders who don't push it as they should, with some even sowing doubt about the vaccine and the virus itself in people's minds. "I think that's a big problem," he said. 

Other findings in the poll: 

• Of those reporting excellent or very good health status, 52% said they would definitely or probably get vaccinated; 33% said they probably or definitely would not; and 15% said they had already received a vaccine at the time of the poll. 
• Older people were more likely to have already received or intended to get a shot, and 37% of Kentucky adults under 45 said they probably or definitely would not get one. 
• At the time of the poll, Kentucky adults living in an urban county were twice as likely to have already received a vaccine compared to those living in a suburban or rural county. 
• Adults living in suburban and rural counties were twice as likely to say they would definitely not get a coronavirus vaccine if it was made available to them, compared to adults living in urban counties. 

The poll questioned a random sample of 807 Kentucky adults in landline and cellphone interviews. Its error margin is plus or minus 3.5 percentage points. The foundation said it plans to survey the same people later this year.

The foundation and its partners have launched two campaigns to encourage Kentuckians to get vaccinated: the I Got the Shot campaign and the Take it From Me campaign.

Stories from a nearby Tennessee county and Bourbon County, Kansas, illustrate rural hesitancy about Covid-19 vaccines

Rural whites, especially conservatives and men, are among the least likely to get a coronavirus vaccine or believe the virus is a serious threat. Two stories from an NPR and Kaiser Health News partnership explore that phenomenon. The first "appears to confirm findings of a national poll in January by the Kaiser Family Foundation that found doubt about vaccines higher in rural areas" from Nov. 30 to Dec. 8, the Louisville Courier Journal reports. So does the second. 

The first story comes from Fort Scott, Kansas, pop. 8,087 and seat of Bourbon County, named for the one in Kentucky. The county lost its hospital in December 2018, and is more than an hour's drive to Kansas City, Sarah Jane Tribble reports. But that didn't seem to affect attitudes of those she interviewed. Many residents don't think Covid-19 is that dangerous, feel unsure about the safety of the vaccine, and say diagnoses could be the flu or other ailments.

Fort Scott in Bourbon County,
Kansas (Wikipedia map)

"Factors such as age and occupation also play a role in attitudes toward the vaccines," Tribble reports. Also, "Rural Americans are more likely to think of getting a vaccine as a personal choice and believe the seriousness of Covid is exaggerated in the news."

Locals have seen evidence of the pandemic: One in 11 of Bourbon County's 14,000 residents have been infected with the coronavirus, and about two dozen have died. "Most people know someone who had the virus and survived — but residents just seem tired of talking about it," Tribble reports.

Jason Wesco, executive vice president of the Community Health Center of Southeast Kansas, a regional health center that took over primary care in Fort Scott after the hospital closed, told Tribble that he believes vaccine hesitancy is declining as supplies become more abundant: "When residents are directly provided the opportunity to get a vaccine, they consider it more seriously, he said. And the more people they know who have gotten a vaccine, the more likely they will be to get a shot."

Hartsville, Tenn. (Wikipedia map) 

The second story comes from Hartsville, pop. 7,870, in Tennessee. There are more than enough vaccines to go around, but the Trousdale County Health Department has had a hard time filling slots at local vaccination drives, Blake Farmer reports.

Local resident Cris Weske told Farmer that he doesn't need the vaccine because he's healthy, and said he's "kind of anti-vax" in general because he believes they're toxic. He claimed the U.S. Constitution supports his choice to opt out of vaccination.

Sometimes vaccine-resistant people's stated reasons are hard to figure. Cindi Kelton is 67 and has COPD and emphysema, both of which put her at high risk of Covid-19 complications, but she told Farmer she's more scared of the vaccine than the virus. She said she had planned to get the vaccine, but in January her doctor died from Covid-19 in January. "It's unclear whether he was vaccinated," Farmer reports. "Either way, Kelton says it gave her pause."

Farmer adds, "To this point, there has been scant attention paid to batting down rumors or answering vaccine questions in many rural communities. Public health officials have been far more focused on underserved groups concentrated in urban areas. But it's rural communities where a few leaders are actively sowing doubts. They include state legislators and even a few pastors."

Ministers are seen as key allies in boosting vaccination in Southern states, where rates are lowest, but most of the ministers participating are from Black churches. Though Black congregations share with rural white residents a distrust of the government, one Black pastor told Farmer that vaccine skepticism can be overcome with outreach efforts.

Another resident, a 74-year-old woman, highlighted another difficulty in boosting rural vaccination rates: She doesn't have a computer and, since local vaccine drives are advertised mostly on social media, she had no idea she was eligible, Farmer reports.

Pike, Woodford, Perry, Fayette and Floyd counties lead Kentucky in full vaccination, Washington Post reports, using CDC data

Screenshot of Washington Post interactive map; click it to enlarge. Click here for interactive version.

By Al Cross

Kentucky Health News

Two pairs of very different Kentucky counties – Pike, Woodford, Perry and Fayette – have the highest percentages of their populations fully vaccinated against the novel coronavirus, according to Centers for Disease Control and Prevention data published Sunday by The Washington Post.

The CDC data show that 23.3% of Pike County's population has been fully vaccinated, well above the state average of 15.3% and the national average of 14.7%. Woodford County ranks second, at 21.6%, followed by Perry County at 21.4% and Fayette County at 21.2%.

Pike and Perry counties are deep in Appalachian Kentucky, while Fayette and Woodford are in the heart of the much more well-to-do Bluegrass, but the first three are all home to major health-care facilities, and most of Woodford County's population has easy access to Fayette, so that could be a factor.

Floyd County, which borders Pike, has a fully-vaccinated rate of 20.1%. It is the only other Kentucky county with more than 20%, according to the Post map produced with the CDC data. It is the first public report of county-by-county vaccination rates, and doesn't include all states because of limited reporting.

The report's interactive map also lists the percentages of adult and senior population that have been fully vaccinated, either one-shot Johnson & Johnson vaccine or both doses of the Moderna or Pfizer vaccines. Pike leads in adult vaccinations with 29.3% and Fayette is tops for 65 and up with 54.6%.

Twenty counties have less than 10% of their populations fully vaccinated, according to the Post map: Adair, Ballard, Calloway, Casey, Christian, Clay, Clinton, Elliott, Graves, Hart, Jackson, Lee, Lewis, McCreary, Meade, Rockcastle, Spencer, Taylor, Todd and Wayne, which has the lowest rate, 6.6%. Other low counties are Spencer, 6.7%; Casey, 6.9%; and Christian, 7.2%.

Jefferson, the state's most populous county, had 15.8% fully vaccinated, half a percentage point above the statewide average. It and Christian County both have large Black populations, and Gov. Andy Beshear has said more than once that the vaccination rate among Kentucky Blacks lags that of whites.

The Post story reports the CDC data show "notably lower rates in predominantly Black areas and counties that voted most heavily for President Donald Trump in 2020." President Biden carried only Fayette and Jefferson counties, but the data suggest that counties where Trump got over 80% have lower vaccination rates.

The Post says it included only counties for which at least 85% of vaccination records included a person’s county of residence: "For the states with usable information, 45 percent of people age 65 and older, 18.2 percent of all adults 18 or older, and 14.3 percent of the entire population are fully vaccinated."

Blacks and whites traded places in Ky. coronavirus statistics as the pandemic became less urban and more rural

Graph by Bruce Maples (click to enlarge); dashed lines show races' share of state population.

By Bruce Maples

Kentucky Health News

As the coronavirus pandemic took off, there was a striking anomaly in the data: African Americans were being infected, and dying, at a rate much greater than their share of the population.

The difference was so great, and so striking, that it drew frequent comment from Gov. Andy Beshear in his daily press conferences. A month into the pandemic, on April 11, he announced that Kentucky Blacks were dying of Covid-19 at a rate two and a half times their 8.4% population share; they were 21% of the deaths in which the person's race was known (81% of cases at the time).

Graph by Bruce Maples; dashed lines are races' share of state's population.

Over the past year, however, the proportion of Blacks in the daily case and death numbers have steadily declined, to the point that they are now roughly the same, or less than, their share of the population.

At the same time, white Kentuckians' shares of Covid-19 deaths have steadily climbed and are now greater than their share of the state's population. Whites' share of cases also rose.

Meanwhile, Asian Americans' share of Covid-19 deaths in Kentucky is now less than their share of the population, reversing the pattern from early in the pandemic, when they were affected by some of the same factors as African Americans, one health expert said.

Dr. Sarah Moyer, director of the Louisville Metro Department of Public Health and Wellness, said many persons of color are "essential workers," often in customer-facing industries such as restaurants and grocery stores, and thus could not work from home. So in the early days, while many people were able to be "healthy at home," the Black and Asian populations in the state had to go into work, and thus were more at risk.

But as things began opening up, white institutions have been more aggressive about doing so, Moyer said: "More white churches went to in-person services. Black churches tended to stay remote. More whites started traveling. And, it's been largely white-majority schools that have pushed to get back into the classroom.

"And, it's just anecdotal, but it seems to me that whites are more willing to take risks."

State's latest report on cases and deaths by race and ethnicity

Donna Arnett, dean of public health at the University of Kentucky, said she suspects the early infection rate among people of color led to some "acquired immunity."

"I don't want to use the term 'herd immunity,' because we aren't clear on just where that line is," Arnett said. "But I do think that the large number of infections could have led to acquired immunity in that population."

She added, "An Indiana study showed that for every reported case, there are about 10 more cases that are not reported and not counted. So, that early spike we see on the graphs actually represents an even larger spike of cases, which may have affected later infections."

In Louisville, Moyer noted most of the people under 60 who are dying of Covid who are under 60 are Black or Hispanic.

One thing that has seemed clear over the past few months is that the rate of infection has dropped in the urban areas in the state, and increased in the rural areas.

The pandemic was later in getting to rural areas, but when it did, it found a vulnerable population that was sicker, older, and has less access to health care, several reports have noted.

WFPL graph shows higher rates of new coronavirus cases in rural counties and one health district.

For example, Louisville's WFPL reported Dec. 23 that the November death rate in the Kentucky River Health District was 107% higher than the statewide rate, so deaths there were 4% of the state total though the district has only 2% of the state's population. Out of 120 counties in Kentucky, only 18 had higher death rates in November than those comprising the Kentucky River district, based in Hazard.

Daily Yonder graph

This trend is national. The Daily Yonder does a weekly look at coronavirus cases and Covid-19 deaths in the rural U.S. Its latest graph clearly shows that the pandemic went from being an urban issue to a rural issue in August of last year, and that the divergence only grew as time went on, until recently.

Now vaccines are widely available, but public-health experts worry that rural residents will be more hesitant to get them, or outright resistant to the idea. They say the same sort of targeted communication that has been directed at communities of color needs to be designed to overcome rural reluctance.

Beshear says new vaccine is 'game changer' and the end of the pandemic is in sight, but masks and distancing are still needed

Margaret Brennan of CBS News interviewed Gov. Andy Beshear on "Face the Nation" Sunday.

By Al Cross

Kentucky Health News

As a new vaccine was released and the coronavirus and Covid-19 kept waning in Kentucky, Gov. Andy Beshear said the end of the pandemic is visible and the third vaccine "is going to be a game-changer."

The Centers for Disease Control and Prevention said the one-shot, easily handled vaccine developed by Johnson & Johnson could be given to anyone over 18, and shipments of it began moving out of the company's distribution center in Bullitt County to locations around the country.

"Johnson and Johnson is going to be a game changer," Beshear said on CBS's "Face the Nation" Sunday morning. "We can fully vaccinate everyone in just one shot . . . and we're going to get tens of thousands of additional vaccines per week, per state. It's just gonna get us to the finish line that much faster."

In a video Sunday afternoon, Beshear said new cases of the virus in the state went down for the seventh consecutive week, with final numbers to come Monday, and vaccinations are going faster than ever. He said that in the current vaccination week, with two days to go, more than 91,191 first doses have been administered, the most yet in a week.

"We're getting these vaccines out faster than the federal government can get 'em to us, and we'll get them to you," Beshear said. "Just make sure that you're patient and don't stop doing what is protecting us right now: Masking up, engaging in social distancing, reducing your contact. We can see the end; the light of the tunnel is getting brighter, and the directions that we're headed are good but we can't quit until we get the job done." 

Daily numbers: Beshear reported only 675 new cases of the virus, the lowest number on a Sunday in almost five months. Testing is down, but so is the percentage of people testing positive; in the last seven days, that figure was 5.02%, the lowest in more than four months.

The seven-day rolling average of new cases, generally the best indicator of the pandemic, fell to 1,094, the first time it has been under 1,100 since Oct. 19. Before the daily number was announced, the state remained 10th in new cases per population, according to a daily compilation by The New York Times.

Hospital numbers were down, except the number of Covid-19 patients on ventilators, which jumped to 118 after dropping to 87 the day before. Covid-19 hospitalizations in Kentucky hospitals totaled 732, down 33 from Saturday, with 187 in intensive-care units, down 22. An unusually large share of the ICU patients, 63 percent, were on ventilators.

The state added 12 more people to the list of people dying of Covid-19, bringing the toll to 4,637. Over the last 14 days, the number of people added to the list after review of cases has averaged 25.4 per day. The state does not issue detailed lists of Covid-19 deaths on weekends.

The state reported a new-case rate of 20.9 per 100,000 residents in the last seven days. Counties with rates more than twice that were Caldwell, 240; Taylor, 61; Lyon, 57.4; Clay, 46.7; and Russell, 42.2. The Caldwell and Lyon numbers appear to come mainly or partly from state prisons.

 

Counties with 10 or more new cases were Jefferson, 180; Fayette, 55; Pulaski, 31; Kenton, 24; Daviess, 16; Boone and Madison, 15; Bullitt, Jessamine and Scott,11; and Lincoln, 10.

National TV: The major premise for Beshear's appearance on "Face the Nation" was his high priority for vaccinating teachers and other school personnel. "We're about to be the first state to fully vaccinate all of our educators," he said, omitting his usual caveat: That doesn't include those who declined a shot.

"For us, this was a workforce issue," Beshear said. "It was development for our children, scholastically, emotionally and socially; and it was about getting back to some form of normal while we were still very careful. We made this call early on, we stuck to it, and no matter what you decide during Covid, some are going to oppose it, but it's about trying to do the right thing, the best thing for your people, and then let the consequences be what they'll be."

Host Margaret Brennan asked why Kentucky is "lagging" in vaccine rollout, at 29th in total vaccinations. Beshear replied, "We don't think that we're lagging," because the state has prioritized first doses. "We believe that we have to be as fast as possible with the first dose, to give people some level of immunity, and as of last week we had used 98.5% of all the first doses provided," he said. "We think differently on the second dose; that is meant for a very specific person, and so we made the decision that if it takes a little longer to get it to them, then we were gonna make sure it gets to them."

Asked about the relief-and-stimulus bill moving through Congress, and Senate Minority Leader Mitch McConnell's criticism of its money for state and local governments, Beshear said, "Every county judge-executive and every mayor across Kentucky, whether Democrat, Republican or independent, they'll tell you they desperately need this assistance."

He added, "This gives us the ability to make up for some of that harm. On the state level, this gives us an opportunity to stimulate our economy without having to borrow or go into debt." It's the federal government that will go further into debt to pay for the $1.9 trillion package. 

Beshear said the nation has a decision to make; "Are we gonna be FDR or are we gonna be Herbert Hoover? Do we want to make the decisions to get us out of this recession more quickly, which benefits every family, Democrat or Republican? But you gotta be bold to do that, and you can't worry about credit, whether it happens under a Democratic president or a Republican president. In the midst of a pandemic, can't we put that aside for just a little but and help all our families out there? I hope so."

Asked about the post-election remark by Sen. Joe Manchin, D-W.Va., that "a radical part of the so-called left" scared off rural voters, Beshear said "Our party, like others, has lots of different people with lots of different views. . . . People are passionate about the views they have, but we also have to be respectful of one another, to make sure that what brings us together isn't who we dislike but it's what we stand for. So when those debates are occurring, if they're actually on issues, then we're moving in the right direction, even if there is disagreement on those issues. I'm highly concerned that what is bringing too many people together in our country is who they dislike and not what they actually stand for."

Randomized coronavirus and antibody testing in Louisville will determine 'true extent' of virus, could be extended to rest of Ky.

By Melissa Patrick
Kentucky Health News

A project aimed at finding out the true extent of the coronavirus in Louisville has moved into its second phase after receiving a $1.5 million donation from the James Graham Brown Foundation, with hopes that it will be replicated across the state and nation, and even the world.

"The project is a national model, and we hope the rest of the country will follow in the coming months," Aruni Bhatnagar, director of the University of Louisville Christina Lee Brown Envirome Institute, said at a news conference Monday, June 8.

The Co-Immunity Project is a collaboration of the Envirome Institute and the Louisville Healthcare CEO Council, along with Louisville’s three major health systems, Baptist Health, Norton Healthcare and UofL Health.

Bhatnagar said invitations bearing a U of L seal have been sent to 13,000 households in all parts of Louisville asking them to participate in free testing for both the coronavirus and its antibodies. Participants will be selected based on age, race, sex, background and location to create a sample that matches Jefferson County's demographics.

Illustration from UC Davis Health

The first phase of the project involved testing nearly 1,500 health care workers for the virus and its antibodies. Tests of the public began with 2,400 people. They will be followed by random tests every eight weeks, with about 22,000 being tested when the project is finished. The first round will be completed by June 20, with the results to be released 10 to 12 days later.

"It is our hope that through this type of regular, representative [testing] is that we will be able to calibrate a response with greater precision in risk group, in timing and in location," he said. "But to succeed, it will depend on the participation of our community."

Initial results from statewide testing in Indiana released in May found that the number of infections was about 11 times higher than had been reported at the time of the tests, and that about 45% of those who tested positive had no symptoms, Marcus Green reports for WDRB.

Bhatnagar explained that while testing capacity has greatly expanded across the state, these results are not representative of the entire population, because they only include people who choose to be tested and this type of testing does "not tell us about the true extent of the virus in our community."

"We need not only expanded testing, but smart and consistent testing," said Bhatnagar "We need to test a random sample of people who are representative of the entire community. Much like a well-designed political poll, we have to be careful to ensure that the  test results from a group of people mirror that of the larger population. Only this can give us a real picture of who has the virus, and who has had the virus."

Bhatnagar said the data from this study will best represent an urban setting, and that he hopes to eventually extend this project to the rest of the state: "It would be somewhat precarious to extrapolate the results from urban areas to rural areas, so I think if this model could be followed in the entire state of Kentucky, then we would in the future like to include both urban and rural locations."

The news release says scientists from around the world can use the data to study effectiveness of antibody therapies and to identify types of individuals who are better able to fight off the virus.

Cell-phone data suggest that we're already staying home less

SafeGraph data for the week ended April 30 show relative mobility. For county data, click here.

Anonymized cell-phone data indicate, county by county, how much Americans are obeying stay-at-home restrictions imposed to fight the covid-19 pandemic. Kentuckians appear to be getting out more.

Data from SafeGraph, as anaylzed and presented by The Washington Post, show that the first week of April was "the peak period of our collective, coronavirus-induced lockdown," but "The numbers vary greatly by geography."

That is made clear from the map that the Post produced from the SafeGraph data; online, it is interactive, giving data by county.

A similar project, by the University of Maryland, presents cell-phone mobility and other data in bar graphs by date. It shows that Kentucky's social-distancing index peaked at 73 on April 12 and gradually declined for the rest of the month, except for weekends. On April 30, it was down to 24, on a scale of 100. That was the lowest it had been since 23 on March 16, the Monday after major shutdowns began. The site has data going back to Jan. 1, and the "Counties" option can be selected to create bar graphs for any county.

UK public-health, surgery professors urge quick hospital and government action to limit deaths from covid-19 in rural Ky.

A public-health professor and a surgeon at the University of Kentucky are sounding the alarm that the covid-19 disease caused by the new coronavirus could devastate rural Kentucky, and they say rural citizens and hospitals need to be more careful.

Tyrone Borders, Ph.D.

Ty Borders, the Foundation for a Healthy Kentucky Endowed Chair in Rural Health Policy, and Sam C. Tyagi, an assistant professor of surgery, wrote a letter to Kentucky newspapers, prompted in part when one of them saw a lack of distancing and testing at a rural hospital.

Sam Tyagi, M.D.

"Anecdotal evidence shows that too many rural citizens and hospital personnel are not heeding federal and state recommendations to reduce coronavirus transmission," they wrote. "It has been observed multiple times that health-care workers who have been exposed are not being quarantined and tested appropriately by these rural and community hospitals, despite requests from the health-care employees."

Rural Kentucky is especially at risk, Borders and Tyagi say: "The first known case of coronavirus in Kentucky was in Cynthiana, a town with a population of only 6,400 persons, and cases of coronavirus have been identified in several other rural communities. The older age compositions and inadequate hospital infrastructures of rural communities place them at extremely high risk for serious cases of coronavirus and mortality."

Very few rural hospitals have the facilities and equipment needed to treat serious cases of covid-19, they wrote: "An inadequate supply of health-care personnel in rural areas severely limits the abilities of critical-access and other rural hospitals to deliver intensive care and respiratory services for patients with coronavirus. Transferring patients from rural to urban hospitals is not a realistic option because many urban hospitals are already facing short supplies." The Lexington Herald-Leader did a story in which Borders and others voiced concerns about rural hospitals.

Borders and Tyagi recommended three immediate steps to limit the spread of the virus and keep rural hospitals from being overwhelmed:

1. Public-service announcements "to better communicate the risk of coronavirus and rationale for social distancing to rural citizens," perhaps adapting one being used in Alabama, including short instructions on social distancing, making hand sanitizer and masks, and handling  mail and other home deliveries.
2. Coordinated coronavirus testing, centralized at hospitals, clinics, health departments, or drive-through testing areas, to "reduce coronavirus exposure among health-care personnel."
3. Expansion of hospital facilities and equipment, especially intensive care units and ventilators. "State government and the hospital industry must carefully coordinate the expansion of hospital capacity," they wrote. "The supply of ICUs and ventilators must be accurately and continually assessed and then reported in a transparent fashion to hospital administrators, clinicians, and the general public."

Urging quick action, Borders and Tyagi concluded, "Government and hospital leaders must act faster than the rate of coronavirus transmission."

Transport and fears of stigma and lack of confidentiality biggest barriers to accessing rural syringe exchanges, study concludes

Counties in study are in red; click on the image to enlarge it.

By Heather Chapman
Kentucky Health News

Rural residents who inject drugs say they are less likely to access syringe exchange programs because of transportation problems, inability to get to the service at times it's open, and concerns about stigma, lack of confidentiality, and law enforcement. So says a newly published study examining barriers that can prevent people who inject drugs (PWIDs) from accessing syringe service programs (SSPs) in Appalachian Kentucky.

The researchers surveyed 186 PWIDs who used their local health department SSPs in three rural counties in 2018: Clark, Knox and Owsley (though Clark is in a metropolitan area, much of it is rural). Kentucky leads the nation in the number of SSPs, partly because it has 120 counties. As of July 2019, it had 52 SSPs that aim to reduce the spread of HIV and hepatitis C by giving PWIDs clean needles and disposing of dirty ones, and often offer more information about addiction treatment services when the person is ready.

Among the study's participants, 53.2 percent were male, 92.5% were non-Hispanic whites, and 78.5% had Medicaid coverage. About 39% said they injected more than one drug; methamphetamine was the single most popular drug, with 45.2% reporting it as the primary drug they inject. The next most popular was non-prescribed buprenorphine, which is sold legally as Suboxone for drug treatment (25.8%), followed by heroin (16.1%), other non-prescribed opioids (11.3%), and various other drugs (1.6%).

The biggest barrier to SSP use was the lack of transportation, with 18.3% reporting it as the primary barrier. Other barriers were: inability to access the program during operating hours, which are often limited (12.9%); concerns about stigma, privacy, and/or law enforcement (9.1%), not enough syringes (5.4%); and the location of the program (4.8%).

Participants' concerns varied based on the degree of their county's rurality. In Clark and Knox counties, the least rural, transportation was the most frequently cited barrier. But in Owsley, the most rural county, fear of stigma and lack of confidentiality ranked highest.

Rurality also factored into participants' consistency in accessing the SSPs. Participants in Knox and Owsley were more likely to consistently use the program than participants in Clark. The researchers believe the more consistent uptake in rural areas is because people in rural areas tend to have higher residential stability. However, Clark County participants may be less likely to consistently use SSPs because they're more likely to have an alternate means of accessing clean needles.

The study is part of a larger National Institutes of Health-funded effort to learn about SSP uptake in rural areas. This study's authors recently published another study about PWIDs in the same three counties, focused on what kind of interventions are most effective and which drug users are most likely to seek treatment.

Regular users of syringe exchanges who say they can decrease opioid use (and don't use meth) are more likely to get treatment

Counties in the study

One of the first studies to explore syringe-service programs in rural counties found that the participants who consistently used a syringe exchange and voiced high confidence in their ability to decrease substance use -- and did not first inject methamphetamine -- had significantly higher odds of participating in treatment, according to a new study.

"These findings support the notion that providing brief motivational and targeted, goal-setting interventions may improve treatment seeking and enrollment," says the study.

The study, published in The Journal of Rural Health, looked at 186 people who injected drugs (PWIDs) and used syringe-service programs, (SSPs) in two rural southeastern Kentucky counties, Knox and Owsley, and Clark, a rural-suburban county near Lexington. The study involved voluntary, on-site, face-to-face interviews about behaviors, injecting practices, syringe service program utilization and treatment services.

Data were collected through an ongoing National Institute on Drug Abuse-funded study designed to examine uptake of SSPs among PWIDs in Appalachian Kentucky.

Partly because it has so many small counties, Kentucky leads the nation in the number of syringe-exchange programs, which allow drug users to swap dirty needles for clean ones to thwart the spread of HIV and hepatitis C, as well as offering other "harm reduction" services.

Kentucky has 62 syringe-exchange programs operating in 55 counties. Four counties have approved a programs that are not yet operational.

Among the 186 participants in the study, 83 of them, or 44.6 percent, reported using a SSP more than six times over six months, which was considered "consistent use" for the purposes of the study.

Asked about the importance of quitting or reducing their substance use, 69.9% (130) of the participants said that was highly important; 17.7% (33) said it was of medium importance and 12.4% (23) said it was of low importance.

However, their confidence in their ability to quit or reduce their substance use was much lower, with 48.4%, (90) of them reporting high confidence; 28.5% (53) voicing medium confidence and 22.6% (42) expressing low confidence.

The researchers found that 21% (39) of the study participants had participated in treatment in the month before they were surveyed.

"Consistent SSP uptake, in terms of number of attended visits, was linked to significantly greater odds of current treatment participation," says the report. Later adding, "Participants reporting high confidence for decreasing substance use had significantly higher odds of treatment participation."

The study also found that participants in these rural exchanges had a higher proportion of newer clients and a higher proportion of repeat users, compared to some urban studies.

It found that more than one-third of the study participants had initiated SSP attendance in the month before the interview, while 28.5% of them had been utilizing the program for six months or longer. Further, 97% of the participants were repeat users.

"These findings indicate that rurally located SSPs are being utilized by high-risk PWID and represent a critical venue for the delivery of harm-reduction services in rural areas," says the report. "Attention to strengthening and resourcing these programs to further increase access (operating with extended hours or in mobile capacities) would appear to be warranted."

It also found that the SSP clients in the study had chronic, longstanding substance-use disorders, with both physical- and mental-health conditions that were significant.

"66% met criteria for past 90-day severe substance-use disorder, and 78% reported severe mental distress in the same time period, indicating that this is an important population to reach with expanded services," the report says.

It points out that nearly half, 47%, of the study participants were female, while urban studies typically have high percentages of males, as high as 70%.

The researchers said they couldn't pinpoint the reason why high confidence to change made consistent injectors of drugs more likely to get treatment. They write, "It is plausible that the association is a result of active, intentional treatment referrals from the SSP, an indirect effect of general social and recovery support available at the SSPs, or increased agency for behavior change that accrues from ongoing successful participation in the SSP. These findings are nevertheless promising and warrant additional investigation."

They also noted that because Kentucky has such high rates of methamphetamine use, it is of particular concern that the study found that people who inject meth first were less likely to be treated.

That "reflects a lack of treatment services designed for methamphetamine users, inadequate treatment capacity, as well as the lack of effective medication-assisted treatment [MAT] for methamphetamine use," the researchers write. "Improving formal access to opioid-focused MAT, and emphasizing combination behavioral and psychosocial therapies and adjuvants to address methamphetamine and other substance use, appears critical."

The study concluded, "Rurally located SSPs may play an important role in supporting confidence and motivation to change substance-use behaviors" and may be critical "for integration and expansion of prevention, health promotion, and treatment linkage services for this under-served population."

The study notes that the findings have several limitations, including that the interviews happened at a single time point and that the data was self-reported, which raises issues of recall and responses that reflect social desirability.