Icelandic Prevention Model for Rural Youth: A Feasibility Study in Central Appalachia

Abstract

The purpose of this study was to assess the feasibility of implementing the Icelandic model for Primary Substance Use Prevention (IPM) in rural Central Appalachia. Guided by the IPM’s theoretical framework, 26 stakeholders from a single county in West Virginia were purposefully recruited during the spring of 2019 and divided into four focus groups. Interviews were recorded and transcribed verbatim and analyzed into themes based on IPM premises. Focus group material produced seven themes: Drug use overall, Drug treatment and other service needs, Poverty, Parenting/Caregiver practices, Transportation, Downtime/Leisure time activities, and Opportunities for solutions. General support was found for the potential of the IPM in the region. Preferably, the implementation of the model should coincide with attention to the adult population as drug use was reported to be plaguing the whole community. Treatment options were few and mostly far away. General poverty and lack of public transportation further stifled progress and potential for change. Organized leisure time activities and programs for youth were scarce and mostly seasonal. Suggested solutions for the adult community included workforce and skill training, coupled with increased opportunities for organized leisure activities for youth, and access to healthy role models via schools and faith-based organizations. We conclude that implementation of the IPM would be feasible to prevent substance use initiation and progression among youth in the rural Central Appalachia. We present several specific recommendations for policy and practice that address factors unique to this environment to initiate the IPM implementation development and suggest initial model application strategies.

Barriers to utilizing substance use disorder treatment and harm reduction services in Appalachia.

“…Lack of access is a widely recognized barrier in Appalachia, especially in rural areas, that contributes to the underutilization of SUD treatment and harm reduction services. There are sometimes no appropriate treatment options available within communities, with the closest available treatment options necessitating long travel distances (Buer et al, 2016; Bunting et al, 2018; Davis et al, 2018; Kristjansson et al, 2022; Leiner et al, 2021). Victor et al (2018) found that incarcerated women with a history of substance misuse who had at least some SUD treatment options nearby where they lived were more than twice as likely to have utilized treatment compared to those without any local SUD treatment options.…”

“…Financial hardship and insufficient insurance coverage for SUD treatment services are a common barrier to treatment utilization in Appalachian communities (Buer et al, 2016; Bunting et al, 2018; Kristjansson et al, 2022; Leiner et al, 2021; MacMaster, 2013). Lack of money and financial resources result in resource swapping within the social networks of PWUD (Buer et al, 2016).…”

“…Lack of childcare is also noted as a primary barrier to treatment, making it difficult for caretakers to attend treatment without bringing children with them or leaving their children unattended (Buer et al, 2016;Lilly et al, 2019). Financial hardship and insufficient insurance coverage for SUD treatment services are a common barrier to treatment utilization in Appalachian communities (Buer et al, 2016;Bunting et al, 2018;Kristjansson et al, 2022;Leiner et al, 2021;MacMaster, 2013). Lack of money and financial resources result in resource swapping within the social networks of PWUD (Buer et al, 2016).…”

Mental health and well-being for the prevention of substance use disorders

“…The model has been successfully implemented among rural communities[ 79 , 80 ] and across diverse geographical settings,[ 81 ] including in lower- and middle-income countries, such as Chile. [ 82 ]…”

Building engagement to support adoption of community-based substance use prevention initiatives

“…Further, there are often initial challenges in building local stakeholder acceptance of the model [ 39 ]. Finally, Kristjansson and colleagues [ 42 ] suggest that there may be barriers specific to rural contexts that interfere with implementation of the IPM, such as limited resources and difficulties for community leaders to recognize the connection between health outcomes and policy.…”