Expert Commentary

Rural Americans concerned about opioids, the economy

A survey of 1,300 adults living in rural America finds they are preoccupied by economic issues and the ongoing opioid epidemic.


A survey of 1,300 adults living in rural America finds they are preoccupied by economic issues and the ongoing opioid epidemic — and most think the government can help solve these problems.

This new survey offers a clearer picture of the people living in rural areas of the country — a group that has received increased attention since the 2016 election. For example, almost half know someone struggling with addiction, almost half of those with adult kids have watched them move away and a majority think better public schools would help their local economies.

For the purposes of the survey, rural was defined as areas that are not part of a Metropolitan Statistical Area (MSA).

According to poll co-director Robert J. Blendon, a professor of public health and health policy at the Harvard T.H. Chan School of Public Health, the survey had the aim of “giving a voice to people about problems in their lives.”

He stressed the survey’s focus on day-to-day issues rather than politics. “It’s about their communities, their lives, their families, what they think should be done to make their communities work better, their aspirations,” Blendon said. “For over a decade, the discussions about rural America have been about serious economic concerns… When we asked people in their own words, it turned out that drug abuse was essentially the same [level of concern as economic issues]. This has never been reported before.”

The survey was conducted between June 6 and Aug. 4, 2018 through phone calls to a nationally representative, probability-based sample. Researchers at the Chan School teamed up with NPR and the Robert Wood Johnson Foundation for the project. (The Robert Wood Johnson Foundation partially funds Journalist’s Resource.)

The respondents were 78 percent white, 8 percent black, and 8 percent Latino. Most of the respondents were not college graduates (80 percent).

According to survey results, 25 percent of respondents named drug addiction or abuse as the biggest problem facing their community. Economic concerns were listed as the biggest problem by 21 percent of respondents.

Blendon also noted that while opioid misuse is often thought to impact just a few rural states, the poll found that concerns about opioid use were widespread across all of rural America.

Forty-nine percent of the respondents surveyed said they personally knew someone who struggled with opioid addiction. A similar percentage (48 percent) said that opioid addiction in their community had gotten worse in the past five years.

However, 51 percent of respondents said they were confident the major problems in their communities will be solved in the next five years. Addressing the apparent contrast in findings with respect to the solvability of worsening crises like the opioid epidemic, Blendon said there is “a gap where people do believe you can make some really short-term progress in treatment and education … a lot of experts say this could be turned around, but it could take decades.”

For big problems, a majority of respondents said they felt help from outside the local community was required to solve them. “Among rural Americans who say they need outside help, 61 percent think the government will play the greatest role in solving major problems facing their local community,” the authors write.

Blendon said this finding came as a surprise given views of rural areas as conservative and resistant to governmental intervention. Thirty percent of rural Americans localized this government help to the state level, while 18 percent suggested the federal government would play the greatest role and 13 percent indicated the county or regional government would be most instrumental.

Despite the problems facing rural Americans, many participants were optimistic about their lives, and valued specific aspects of rural life. “In terms of overall expectations, most rural Americans say their lives have turned out either better than they expected (41 percent) or about like they expected (42 percent), while only 15 percent say their lives have turned out worse than they expected,” the report states. Just over 20 percent of respondents named the closeness of their community as its biggest strength. Following closeness as the top answer, 11 percent thought their community’s biggest strength was “being around good people” and 11 percent appreciated living in a small town.

A majority of rural Americans believe their communities will have increased or steady job opportunities in the next five years, according to the survey. In addition, the authors write, “39 percent of rural Americans believe the number of good jobs in their local economy will increase, while 47 percent believe they will stay about the same, and only 12 percent believe they will decrease.”

However, 43 percent of rural parents of children over age 18 said their children had moved out of the local community. Further, 65 percent of parents whose adult children moved away said their children left primarily for job-related reasons. “The people we interviewed had stayed and mostly were employed,” Blendon explained. He added that their responses to the question about job opportunities might have reflected their personal experiences, while questions about their children shifted the frame of reference.

“The basic thing is people who remain are pretty satisfied with their lives, but they’re aware that a lot of their kids had to leave to find better opportunities,” he said. And rural Americans agreed that the two strategies most beneficial to their local economies would be creating better long-term job opportunities (64 percent) and improving the quality of local public schools (61 percent).


Looking for more on rural America? Journalist’s Resource has a tip sheet on covering the area, as well as research on rural health.