Patterns of Felt Stigma Among Rural-Dwelling People Who Use Drugs: A Latent Class Analysis
Author Department
Medicine
Document Type
Article, Peer-reviewed
Publication Date
12-2025
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.
Keywords: Stigma; latent class analysis; opioids; rural health; substance use.
Recommended Citation
Sibley AL, O'Shea NC, Muessig KE, Noar SM, Barry CM, Gicquelais RE, Wyse JJ, Cook R, Young AM, Tsui JI, Mixson LS, Smith GS, Feinberg J, Seal DW, Jenkins WD, Friedmann PD, Khoury D, Miller WC, Go VF. Patterns of Felt Stigma Among Rural-Dwelling People Who Use Drugs: A Latent Class Analysis. Subst Use Misuse. 2025 Dec 8:1-13. doi: 10.1080/10826084.2025.2597459. Epub ahead of print.
PMID
41362103