Patterns of Felt Stigma Among Rural-Dwelling People Who Use Drugs: A Latent Class Analysis.
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| Title: | Patterns of Felt Stigma Among Rural-Dwelling People Who Use Drugs: A Latent Class Analysis. |
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| Authors: | Sibley, Adams L. (AUTHOR), O'Shea, Nisha C. (AUTHOR), Muessig, Kathryn E. (AUTHOR), Noar, Seth M. (AUTHOR), Barry, Caroline M. (AUTHOR), Gicquelais, Rachel E. (AUTHOR), Wyse, Jessica J. (AUTHOR), Cook, Ryan (AUTHOR), Young, April M. (AUTHOR), Tsui, Judith I. (AUTHOR), Mixson, L. Sarah (AUTHOR), Smith, Gordon S. (AUTHOR), Feinberg, Judith (AUTHOR), Seal, David W. (AUTHOR), Jenkins, Wiley D. (AUTHOR), Friedmann, Peter D. (AUTHOR), Khoury, Dalia (AUTHOR), Miller, William C. (AUTHOR), Go, Vivian F. (AUTHOR) |
| Source: | Substance Use & Misuse. 2026, Vol. 61 Issue 8, p1123-1136. 14p. |
| Subjects: | Substance abuse risk factors, Cross-sectional method, Health services accessibility, Drug overdose, Independent living, Research funding, Interviewing, Multiple regression analysis, Questionnaires, Structural equation modeling, Descriptive statistics, Psychology of drug abusers, Longitudinal method, Odds ratio, Rural population, Research, Patient-professional relations, Data analysis software, Confidence intervals, Social stigma, Sensitivity & specificity (Statistics) |
| Abstract: | Background: Stigma is a barrier to help-seeking in rural-dwelling people who use drugs. However, little is known about whether stigma is experienced in patterned ways, and what characteristics are associated with these patterns. Methods: Data came from a cohort of people who use drugs at eight geographically diverse Rural Opioid Initiative sites (n = 3048). We used three-step latent class analysis to classify participants by patterns of felt substance use stigma, then used multinomial logistic regression to explore demographic, health, and substance-related covariates associated with class membership. Results: Based on fit statistics and interpretability, we selected a five-class solution. Four classes were patterned by severity: Low Stigma (23.7%), Medium-Low Stigma (12.5%), Medium-High Stigma (34.9%), and High Stigma (24.7%). The fifth class ("High Fearers/Low Perceivers," 4.3%) reported high shame and fear of rejection but low perceived stigma from others. Members of higher stigma classes were more likely to have criminal-legal system involvement, inject drugs, and avoid healthcare and drug treatment. In contrast analyses, "High Fearers/Low Perceivers" were more likely to be younger and women, and less likely to have criminal-legal system involvement, experience homelessness, or inject drugs compared with other classes. Conclusion: Rural people who use drugs experience substance use stigma in distinct severity-based patterns, with four classes ranging from low to high stigma across all dimensions. A fifth, smaller class reports high internalized stigma despite low perceived stigma from others, potentially suggesting non-disclosure of substance use. These distinct profiles and their correlates offer targets for tailored stigma interventions. [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
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| Abstract: | Background: Stigma is a barrier to help-seeking in rural-dwelling people who use drugs. However, little is known about whether stigma is experienced in patterned ways, and what characteristics are associated with these patterns. Methods: Data came from a cohort of people who use drugs at eight geographically diverse Rural Opioid Initiative sites (n = 3048). We used three-step latent class analysis to classify participants by patterns of felt substance use stigma, then used multinomial logistic regression to explore demographic, health, and substance-related covariates associated with class membership. Results: Based on fit statistics and interpretability, we selected a five-class solution. Four classes were patterned by severity: Low Stigma (23.7%), Medium-Low Stigma (12.5%), Medium-High Stigma (34.9%), and High Stigma (24.7%). The fifth class ("High Fearers/Low Perceivers," 4.3%) reported high shame and fear of rejection but low perceived stigma from others. Members of higher stigma classes were more likely to have criminal-legal system involvement, inject drugs, and avoid healthcare and drug treatment. In contrast analyses, "High Fearers/Low Perceivers" were more likely to be younger and women, and less likely to have criminal-legal system involvement, experience homelessness, or inject drugs compared with other classes. Conclusion: Rural people who use drugs experience substance use stigma in distinct severity-based patterns, with four classes ranging from low to high stigma across all dimensions. A fifth, smaller class reports high internalized stigma despite low perceived stigma from others, potentially suggesting non-disclosure of substance use. These distinct profiles and their correlates offer targets for tailored stigma interventions. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 10826084 |
| DOI: | 10.1080/10826084.2025.2597459 |
