title: Rural/urban residence, access, and perceived need for treatment among African American cocaine users.
abstract: OBJECTIVE
  To examine how rural/urban residence, perceived access, and other factors impede or facilitate perceived need for drug use treatment, a concept closely linked to treatment utilization.
  
  
  METHODS
  Two hundred rural and 200 urban African American cocaine users who were not receiving treatment were recruited via Respondent-Driven Sampling and completed a structured in-person interview. Bivariate and multivariate analyses were conducted to test the associations between perceived need and rural/urban residence, perceived access, and other predisposing (eg, demographics), enabling (eg, insurance), and health factors (eg, psychiatric distress).
  
  
  RESULTS
  In bivariate analyses, rural relative to urban cocaine users reported lower perceived treatment need (37% vs 48%), availability, affordability, overall ease of access, and effectiveness, as well as lower perceived acceptability of residential, outpatient, self-help, and hospital-based services. In multivariate analyses, there was a significant interaction between rural/urban residence and the acceptability of religious counseling. At the highest level of acceptability, rural users had lower odds of perceived need (OR = 0.21); at the lowest level, rural users had higher odds of perceived need (OR = 3.97) than urban users. Among rural users, the acceptability of religious counseling was negatively associated with perceived need (OR = 0.65). Ease of access was negatively associated (OR = 0.71) whereas local treatment effectiveness (OR = 1.47) and the acceptability of hospital-based treatment (OR = 1.29) were positively associated with perceived need among all users.
  
  
  CONCLUSIONS
  Our findings suggest rural/urban disparities in perceived need and access to drug use treatment. Among rural and urban cocaine users, improving perceptions of treatment effectiveness and expanding hospital-based services could promote treatment seeking.
authors.affiliation: Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, Kentucky.
authors.forename: Tyrone F
authors.initials: TF
authors.lastname: Borders
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Booth
authors.forename: Katharine E
authors.initials: KE
authors.lastname: Stewart
authors.forename: Ann M
authors.initials: AM
authors.lastname: Cheney
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Curran
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D003042:Cocaine; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D012424:Rural Population / Q000706:statistics & numerical data; D016320:Substance Abuse Treatment Centers; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D003042:Cocaine
keywords: access; cocaine; illicit drug; perceived need for treatment; rural