Assessing County-Level Vulnerability for Opioid Overdose and Rapid Spread of Human Immunodeficiency Virus and Hepatitis C Infection in South Dakota.

BACKGROUND: Key indicators of vulnerability for the syndemic of opioid overdose, human immunodeficiency virus (HIV), and hepatitis C virus (HCV) due to injection drug use (IDU) in rural reservation and frontier counties are unknown. We examined county-level vulnerability for this syndemic in South Dakota. METHODS: Informed by prior methodology from the Centers for Disease Control and Prevention, we used acute and chronic HCV infections among persons aged ≤40 years as a proxy measure of IDU. Twenty-nine county-level indicators potentially associated with HCV infection rates were identified. Using these indicators, we examined relationships through bivariate and multivariate analysis and calculated a composite index score to identify the most vulnerable counties (top 20%) to this syndemic. RESULTS: Of the most vulnerable counties, 69% are reservation counties and 62% are rural. The county-level HCV infection rate is 4 times higher in minority counties than nonminority counties, and almost all significant indicators of opioid-related vulnerability in our analysis are structural and potentially modifiable through public health interventions and policies. CONCLUSIONS: Our assessment gives context to the magnitude of this syndemic in rural reservation and frontier counties and should inform the strategic allocation of prevention and intervention services.

Evaluation of school tobacco-free policies in a rural Northern Plains state.

BACKGROUND: The Centers for Disease Control and Prevention (CDC) has called for tobacco-free school (TFS) policies. In South Dakota (SD), a rural state with a large American Indian population, collaboration between state agencies focused on development and dissemination of a model TFS policy in 2008. This study explored the current status of TFS policies in statewide SD school districts. METHODS: Tobacco policies were requested from all SD school district administrators. A 26-point checklist based on CDC TFS policy guidelines was used to evaluate policies. Follow-up interviews were conducted with selected superintendents. RESULTS: Policies were received from 144 of 217 districts (66% response). Participation was higher for public districts than tribal/Bureau of Indian Education (BIE) districts and nonpublic districts. The overall mean policy score was 11.6 (SD 5.1). Public school districts had the highest mean (12.3) followed by nonpublic (8.9) and tribal/BIE (7.5). In a subset of districts with a large American Indian population (>30%), policy scores were lower for those located on reservation or tribal lands compared with other locations. Barriers to policy development were identified as time and staff expertise. CONCLUSIONS: There is a need to improve statewide TFS policies. A district report card with recommendations for improvement and a resource guide were developed and disseminated.