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Accounting for rural versus urban differences in the opioid epidemic in Pennsylvania

Warwick, John S (2018) Accounting for rural versus urban differences in the opioid epidemic in Pennsylvania. Master's Thesis, University of Pittsburgh. (Unpublished)

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In Pennsylvania, rural and urban communities can differ in the various factors that impact healthcare outcomes. The social ecological model was used as a lens to view underlying factors in the literature related to the opioid epidemic that affect an individual’s susceptibility to opioid use disorder in rural and urban populations. The Substance Abuse and Mental Health Services Administration treatment provider search function was used to examine rates of buprenorphine, drug and alcohol and mental health, and detoxification providers across the Commonwealth of Pennsylvania. Following the literature review and provider search, several factors were viewed to affect rural populations moreso than urban populations: the occupation of an individual, social networks, recovery support services, and access to buprenorphine and detoxification providers. Several factors were also found to be similar between urban and rural populations: individual risk factors, perceived norms towards substance use disorder, family, peer influence, stigma, socioeconomic status, rates of drug and alcohol and mental health treatment providers, and policies related to substance use disorder.
All these factors also have the ability to intermix and impact outcomes, such as perceived norms and stigma, which can combine to create low levels of access to treatment and recovery services. Several strategies could be used to overcome these barriers to care in rural populations. Behavioral health can be integrated into primary care offices. Telemedicine can be fully optimized to increase access to specialty services in rural communities. Finally, Medicaid policies can be adapted to make these strategies more achievable for providers of rural healthcare clinics. By incentivizing and increasing reimbursement for medication-assisted treatment and opioid use disorder management and prevention, Medicaid beneficiaries can have increased access to treatment necessary for recovery. In the future, public health policies and interventions that take both the differences and similarities of rural and urban communities into account, can have greater success in overdose reduction and decreasing rates of opioid use disorder across Pennsylvania and the United States.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Warwick, John Sjow81@pitt.eduJOW81
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairTerry, Martha Amaterry@pitt.eduMATERRY
Committee MemberHawk, Mary Emeh96@pitt.eduMEH96
Committee MemberBuchanich, Jeanine Mjeanine@pitt.eduJEANINE
Date: 28 June 2018
Date Type: Publication
Defense Date: 18 April 2018
Approval Date: 28 June 2018
Submission Date: 10 April 2018
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 71
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Rural, Urban, Social Ecological Model, Opioid, Medicaid
Date Deposited: 28 Jun 2018 19:50
Last Modified: 28 Jun 2018 19:50


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