# Understanding the Opioid Epidemic in Rural Ohio: A Mixed-Methods Analysis of Moral Values, Stigma, and Medication for Opioid Use Disorder (MOUD)

> **NIH NIH F31** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2020 · $37,546

## Abstract

Abstract
Opioid-related mortality in the U.S continues to rise, particularly in the rural Appalachian region of the country.
Increased availability of and access to evidence-based treatment for opioid use disorder, such as medication
for opioid use disorder (MOUD) is needed to successfully address the epidemic; however, stigma among
healthcare providers and community members as well as internalized stigma among people who use drugs
(PWUD) are substantial barriers to MOUD availability and uptake in rural Appalachia. While public health
efforts to address opioid use and treatment have often focused on stigma reduction, there is a need for
interdisciplinary work to understand the forces underlying this stigma in rural Appalachian communities. In
particular, cultural factors such as moral views may have critical consequences for drug- and MOUD-related
stigma in these areas. The goal of the proposed research is to understand the relationship between moral
views, stigma, and uptake of MOUD among people who use drugs in rural Appalachian Ohio, as well as to
explore moral views and perceptions of MOUD among healthcare providers and community stakeholders. An
understanding of the moral perceptions underlying or driving stigma in this region is critical for implementing
more successful stigma reduction interventions and increasing access to evidence-based care for opioid use.
Two theoretical frameworks from the emerging field of moral psychology, Moral Foundations Theory (MFT) and
the Theory of Dyadic Morality (TDM), offer explanations for the potential pathway between moral worldview,
stigma, and approval of MOUD. Testing these theories in the field of opioid research will strengthen
interdisciplinary work between the fields of psychology and public health, contributing novel, valuable
knowledge to both areas and forging connections for increased collaborative work in the future. Study aims will
be completed within the context of a larger NIDA-funded Rural Opioid Initiative in rural Appalachian Ohio
(Implementing a Community-Based Response to the Opioid Epidemic in Rural Ohio, UG3/UH3DA044822).
Aim 1 will utilize Confirmatory Factor Analysis testing to assess the validity of instruments associated with MFT
and TDM constructs in a rural Appalachian population of PWUD. Aim 2 will utilize structural equation modeling
to examine the relationship between moral views and uptake of MOUD among PWUD, and explore potential
mediation by internalized stigma. Aim 3 will involve qualitative interviews with treatment providers, PWUD, and
other community stakeholders, to further understand moral perceptions and conceptualization of addiction and
how these shape attitudes toward drug use and treatment. Through this proposed mixed-methods study, the
applicant's background in biological sciences and public health will be strengthened and expanded to include
expertise in social and moral psychology. Furthermore, mentorship experience with renowned faculty in health
behavior,...

## Key facts

- **NIH application ID:** 10066963
- **Project number:** 1F31DA052139-01
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Christine Schalkoff
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $37,546
- **Award type:** 1
- **Project period:** 2020-08-01 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10066963

## Citation

> US National Institutes of Health, RePORTER application 10066963, Understanding the Opioid Epidemic in Rural Ohio: A Mixed-Methods Analysis of Moral Values, Stigma, and Medication for Opioid Use Disorder (MOUD) (1F31DA052139-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10066963. Licensed CC0.

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