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Perceptions of Opioid Misuse in Mississippi Agricultural Communities: Focus Group Findings
Devon Meadowcroft1,*, Mary Nelson Robertson2, Marina Denny3, Martha Rayner2, Amanda Stone2, Jeff Johnson2, David Buys2
Published in Journal of Agricultural Safety and Health 29(1): 47-56 (doi: 10.13031/jash.15250). Copyright 2023 American Society of Agricultural and Biological Engineers.
1Delta Research and Extension Center, Mississippi State University, Mississippi, USA.
2Mississippi State University, Mississippi State, Mississippi, USA.
3Oregon State University, Corvallis, Oregon, USA.
*Correspondence: dm3167@msstate.edu
The authors have paid for open access for this article. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License https://creative commons.org/licenses/by-nc-nd/4.0/
Submitted for review on 27 June 2022 as manuscript number JASH 15250; approved for publication as a Research Article by Associate Editor Dr. Casper Bendixsen and Community Editor Dr. Michael Pate of the Ergonomics, Safety, & Health Community of ASABE on 22 November 2022.
Highlights
Abstract. Opioid misuse has been identified as a concern among the farming community. The aim of this study is to identify how opioid misuse is perceived in agricultural communities across the state of Mississippi. A series of focus groups were conducted with University Agricultural and Natural Resource Extension agents and agricultural producers in Mississippi between November 2020 and February 2021. Focus group transcripts were analyzed through thematic analysis. Both university Extension agents and agriculture producers believe that opioid misuse is more of a concern in the greater rural community, amongst younger individuals, as opposed to being a concern for producers themselves. Extension agents stated that the unique personalities of agricultural producers might prevent them from being upfront about any of their opioid misuse. Agricultural producers stated that alcohol misuse is more of a concern among their peers than opioid misuse and that opioid misuse is present in farm labor. Generally, the focus groups revealed that participants did not think that opioid misuse was an issue for agricultural producers in Mississippi. However, participants identified other groups in their communities as having issues with opioids. The private nature of agricultural producers could be a reason why opioid misuse is not perceived to be widespread in that group. Alcohol misuse was observed as an issue for agricultural producers in the producer focus groups.
A previous survey conducted with rural adults found that three out of four farmers and farm workers stated that they have been directly affected by the U.S. opioid crisis (Morning Consult, 2017). Indeed, the farming community has been impacted by opioid misuse throughout the opioid epidemic. In Massachusetts, researchers examined how opioid-related overdose deaths varied by the occupation of the decedent. Persons who worked in the farming, fishing, and forestry industry classifications had an opioid overdose death rate that was five times higher than the average for all the workers in any industry in Massachusetts (Massachusetts Department of Public Health, 2018). Opioid misuse has also been projected to negatively affect the agricultural economy. It was estimated that the agricultural sector in Missouri will lose about 1,600 jobs in a given year (using 2019 employment data) due to opioid misuse by the labor force. That will decrease the agricultural sector’s output in the state by about $158 million (White and Spell, 2021).
There are several potential reasons why the farming community has been affected by the opioid epidemic. Farming and jobs in agriculture are high-risk jobs with a strong likelihood of being injured on the job (The National Institute for Occupational Safety and Health, 2021), which can lead to being prescribed an opioid for pain management. Being prescribed an opioid for chronic, non-cancer-related pain management puts individuals at a higher risk for developing an opioid use disorder (Edlund et al., 2014). In Montana, it was observed that employees involved with farming and ranching had the highest percentage of receiving an opioid prescription after filing a worker’s compensation claim out of all workers from 2012 through 2017 (Lake, 2019). Likewise, a nationally representative sample of workers in the agricultural industry was found to have an opioid prescription at a 27% higher rate in comparison to workers in management and finance (Asfaw et al., 2020). Another explanation for opioid misuse in the agricultural community could be due to the stressful nature of the occupation. Farmers oftentimes work long hours and are faced with changing factors like the weather, commodity prices, input costs, and government regulations. Past research has found that work-related stress can be associated with illicit drug misuse (Frone, 2008).
To better understand issues pertaining to rural mental health among agricultural producers in Mississippi, the authors conducted several focus groups in 2020 and 2021. These focus groups asked participants a subset of questions on perceived opioid use in their rural, farming communities. Participants included university Extension agents and agricultural producers, who attended the focus groups separately. The transcripts from the focus groups were then assessed through thematic analysis, and the themes found in the agent and agricultural producer groups were compared. The findings of this study provided insight into how persons involved with agriculture in Mississippi perceive opioid use in their communities.
Methods
Sampling and Procedures
All procedures and materials for this study were reviewed before the study began by the Mississippi State University Institutional Review Board. Focus groups were chosen as the primary data collection method to allow the research team to reach more participants as opposed to conducting individual interviews. Additionally, focus groups allow for conversation amongst participants, which promotes the discussion of shared and individual experiences. To recruit participants for the focus groups, a variety of methods were employed. Agricultural and Natural Resource (ANR) University Extension agents were targeted for the focus groups due to their knowledge of the local agricultural community and because they work closely with the farmers in their area. The research team reached out to Regional Extension Coordinators to identify ANR Extension agents who would be appropriate for this study, and the agents were then contacted. Agricultural producers were recruited by utilizing existing relationships between the research team and producers, asking ANR Extension agents to identify producers they knew, and then through snowball sampling once a producer confirmed that they would participate. For this study, row crop and dairy producers in Mississippi were targeted in the recruitment process. Row crops are a significant commodity in Mississippi agriculture in terms of acres planted and harvested (United States Department of Agriculture, 2021). Dairy producers were included in the focus groups due to the connections the research team had with that industry in the state and because dairy farmers in the U.S. have been faced with several economic challenges in recent years, leading to financial stressors for producers (Kaika, 2019).
In total, eight focus groups were held in person at various University Extension office locations between 16 November 2020 and 9 February 2021. Because these focus groups were held in person during the pandemic, University COVID-19 safety measures were adhered to, including social distancing, wearing masks, and temperature checks. Focus groups were carried out during this period to avoid the harvest and planting seasons for row crop producers and previously scheduled commitments during the fall semester for ANR Extension agents. Four of the focus groups were conducted with only ANR Extension agents, three were conducted with only row crop producers, and one was held with only dairy producers. Focus groups were held in each of the four University Extension regions across the state of Mississippi (Delta, Northeast, Central, and Coastal). The focus groups lasted about two hours in length. On average, each focus group had about five participants, with the smallest groups having three and the largest having seven. Two members of the research team were selected to be moderators for the focus groups. One of the research team members specialized in farm management and led the focus groups with the Extension ANR agents and row crop producers. The other moderator was the state dairy specialist, who held the focus group with dairy producers. At the end of the focus groups, a short survey was given to participants. This survey included questions on basic demographics, what commodities were produced in their area, and on-farm financial management topics. Although four focus groups were held with ANR Extension agents, this study only analyzes the results from three of those focus groups. One focus group is excluded from the analysis due to a moderator error made during the focus group.
Focus Group Facilitation Guide
The focus group facilitation guide used by the moderators to lead the discussions was developed by the research team. Figure 1 shows a screenshot of the facilitation guide used for the focus groups. The guide included a series of question prompts on topics such as stressors related to farming, resource gaps in the community, and the best delivery methods to disseminate Extension programs. For the purposes of this article, we are presenting data only on the statements made by the focus group participants following the question prompts on opioid misuse in the agricultural community. Participants were first asked about the coping mechanisms they observed in response to the stressors associated with farming among agricultural producers. The verbiage used by the moderators then depended on whether the focus group participants mentioned opioids or painkillers as a coping strategy to deal with farming-related stressors or omitted to mention opioids as a coping strategy. In either case, the moderator gave a short description of what an opioid or painkiller is and then provided some examples of commonly prescribed opioids. Then, the moderator asked the participants if they thought opioid use was widespread in the farming community and in their county, and then how they observed the impact of opioid use in farming operations.
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| Figure 1. Screenshot of Focus Group Facilitation Script. |
Analysis
The focus groups’ audio was recorded and was then sent to a paid transcription service following the conclusion of the sessions (Same Day Transcription Service, 2020). One of the members of the research team read the transcriptions for accuracy before the analysis process began. The analysis process followed the thematic analysis process described in a study by Braun and Clarke (2006). Four members of the research team read the transcriptions, coded the scripts individually, and developed themes based on their coding. Then, the four members of the team came together to come to a consensus about the themes observed from the Extension ANR agent and producer focus groups.
Results
Descriptive Statistics for Participants
Table 1 displays the descriptive statistics for the focus group participants. In total, 17 Extension agents participated in the three focus groups. Twenty-one producers participated in the four focus groups. For both the Extension agents and producers, the majority of the participants were male, white, and non-Hispanic. The Extension agents were 48 years old on average, and the producers were 56 years old on average. This sample of producers from the focus groups is representative of the population of agricultural producers in Mississippi. Recent Census data from the National Agricultural Statistics Service shows that in Mississippi, about 67% of producers are male, 86% are white, 99% are non-Hispanic, and their average age is 58.9 (United States Department of Agriculture, 2017). This sample resembles the population of agricultural producers in the state when it comes to race and age but is not representative when looking at sex or ethnicity.
| Table 1. Descriptive Statistics of Focus Group Participants. | ||||
| University Extension Agents | Agricultural Producers | |||
| Total N | 17 | 21 | ||
| Variable | N/% | N/% | ||
| Male | 13/76.5 | 18/85.7 | ||
| White | 15/88.2 | 18/85.7 | ||
| Non-Hispanic | 17/100 | 20/95.2 | ||
| M (SD) | M (SD) | |||
| Age (years) | 48 (9.8) | 56 (14.9) | ||
Thematic Analysis
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| Figure 2. Focus Group Perceptions Regarding Opioid Misuse Among the Farming Community. |
Figure 2 displays a Venn diagram, including the themes corresponding to how the focus group participants perceived opioid misuse in the agricultural community. One of the themes (the “personality of agricultural producers may prevent individuals from discussing opioid misuse”) was only stated by Extension ANR agents during their focus groups. Two of the themes (“opioid and drug misuse is a problem in the greater community but not among agricultural producers” and “opioid misuse is more common among the younger generation”) were expressed by both the Extension ANR agents and agricultural producers. Two of the themes (“Alcohol is more of a problem among agricultural producers than opioids” and “Opioid misuse is present more in farm labor”) were only noted by agricultural producers during their focus groups.
Personality of Agricultural Producers
Extension agents noted that the personalities of those who work in agriculture could be a reason why they are unaware of opioid misuse in the farming community. Agents expressed that typically, the producers they work with are private individuals who do not like to openly talk about their issues. Agents are aware that agricultural producers are burdened with stressors; however, they are not knowledgeable of whether opioids are being used as a coping mechanism. As one agent stated:
“So, that's one thing that--it's hard because you don't know what they're doing. And you know they're stressed, but you don't know how they're coping with it--and they could be using drugs or using opioids, but it's just something that they're keeping secret or something they don't talk about.”
Agents also mentioned that agricultural producers could perceive opioid misuse as a weakness of theirs and would want to keep it private due to pride. Agents said that in particular, pride is an issue for the older generation of agricultural producers.
Greater Community vs. Agricultural Producers
Both Extension ANR agents and agricultural producers agreed that opioid and drug misuse is a significant issue in the rural communities where they reside; however, they stated that these issues are not widely present among agricultural producers. Focus group participants came to this conclusion based on their previous experiences working in a hospital or knowing someone who does, and through viewing drug deals outside of local businesses. However, focus group participants were careful to make the distinction that opioid and other drug misuse is not a widespread concern for the farmers themselves. It was expressed by participants that opioid misuse might not be as prevalent on farms due to the precarious situation that most farms are in and that the misuse of opioids could lead to the collapse of the operation.
Younger Generation
Another sentiment echoed by both Extension ANR agents and agricultural producers is that opioid misuse is more common among the younger generation in rural communities as opposed to the oftentimes older heads of farming operations. One agent noted that:
“I have more producers talk to me about their grown children that have those problems. Not the farmer.”
Focus group participants cited the more social lifestyle of the younger generation as a reason behind their perceived opioid or drug misuse. Participants also noted that the lack of in-person socialization brought on by COVID-19-related restrictions could have led younger persons to seek out other, more illicit methods for stress relief.
Alcohol Misuse
In the agricultural producer focus groups, one of the themes that emerged was that alcohol misuse was more of a concern for their peers than opioid misuse. Agricultural producers perceived alcohol misuse as a more frequent occurrence among other producers. As one producer said:
“Yeah, I would say alcohol in this area among farmers is a serious thing, for sure, more so – opioids are definitely serious, but it's [alcohol is] a more common thing.”
Agricultural producers also expressed that alcohol misuse is typically more noticeable, which is why they might perceive it as a more pressing problem than opioid misuse. Alcohol was also mentioned by the producers as a coping mechanism used by farmers to handle the stressors associated with their job.
Farm Labor
Another theme found in the agricultural producer focus group was that they expressed that opioid misuse is more of a concern for younger farm workers as opposed to older farm owners. This theme is consistent with the observation made in both the agricultural producer and Extension agent focus groups that younger people are perceived to have more problems with opioid and drug misuse. During a focus group, one producer stated:
“…It wouldn't be unusual to have on an average-sized farm to have two workers on some kind of painkiller.”
This quote supports the notion that opioid misuse among farm workers is thought to be prevalent among operations by focus group participants. It was also expressed during the focus groups that the agricultural producers themselves have had experiences with their own labor potentially using drugs or opioids. One producer noted having to dismiss an employee due to concerns about substance misuse. Another producer mentioned their employees’ not showing up to work on time, getting over injuries very quickly, and inexplicably losing their teeth as reasons why they think their workers are misusing drugs.
Conclusions
Findings from the focus groups described in this study serve as a depiction of how opioid misuse among the agricultural community is perceived by persons in rural areas. The results from this study suggest that the prevalence of opioid-related issues varies depending on the subset of employees within the agricultural industry. Generally, the themes from the focus groups reflect that participants did not believe opioid misuse was an issue among agricultural producers. However, participants expressed that opioid misuse was a concern among other groups in their communities, including among farm workers. Younger males who have lower levels of educational attainment and employment were identified as being a group at high risk of substance misuse in rural Appalachia (Schalkoff et al., 2020). This categorization aligns with those identified as having more prominent issues with drug and opioid use by the focus group participants. A recent study discovered similar findings regarding opioid misuse among agricultural workers. In a survey of owners and co-owners of such agricultural businesses, almost 95% reported that they have had at least one employee with an opioid misuse issue (Radunovich et al., 2022).
One reason why opioid misuse was not perceived to be widespread among agricultural producers could be due to their general personalities. Extension agents that participated in the focus groups noted that the private and prideful nature of agricultural producers could be a reason why they are unaware of any opioid use amongst those individuals. In interviews with relatives of male farmers who died by suicide in Australia, interviewees echoed that the farmers oftentimes had soft-spoken personalities and that they hid their feelings to comply with the cultural norms of the profession (Kunde et al., 2018). Similarly, interviews with male farmers in North Carolina revealed that they rarely rely on social support networks or their family members when dealing with farm-related stress (Marcom et al., 2018). Pride was also identified as being prevalent amongst older farmers, which was explained in an article as being a result of their many years of work on their agricultural operations (Gullette, 2017). The agents also theorized that agricultural producers might be unwilling to disclose opioid misuse, as it would be perceived as a weakness. The general stigma associated with opioid and substance misuse in rural communities may also be a factor in agricultural producers' refusal to disclose any opioid use to others. It has been found that in rural areas, it is difficult to avoid and remove the reputation of a person who uses drugs due to the small, close-knit nature of these communities (Ezell et al., 2021). The stigma associated with these issues has also been identified as a deterrent for people seeking substance abuse treatment in rural areas (Browne et al., 2016; Jackson and Shannon, 2012).
Even though opioid use was not identified in the focus groups as an issue for agricultural producers, alcohol was singled out as a substance commonly used by farmers. Past work done in Spain found that male farmers drink alcohol at higher rates in comparison to those that do not farm (Zhao et al., 2019). It was brought up during the focus groups that perhaps the participants perceived alcohol use as being an issue among agricultural producers due to it being a more outwardly noticeable problem in comparison to opioid misuse. Similarly, in a survey of over 300 individuals living in a rural Appalachian community, only 12.5% agreed with the statement that they could clearly identify a person with an opioid use disorder (Beachler et al., 2021). Another matter mentioned in the focus groups is that agricultural producers use alcohol as a coping strategy for farm-related stressors. Alcohol misuse was identified as a coping mechanism for farmers by agricultural stakeholders in the midwestern region of the U.S. (Henning-Smith et al., 2022). Efforts in the future should focus on moving farmers towards healthier coping mechanisms for farm-related stress. The alcohol consumption by farmers described in the focus groups could be detrimental to their agricultural operations. In Colorado, the frequency of drinking alcohol and the number of alcoholic drinks consumed by those on a farm were associated with the risk of being injured while performing farm work (Stallones and Xiang, 2003).
Limitations and Future Directions
This study includes several limitations. First, related to generalizability, the focus groups were only conducted in one state in the U.S., with the findings only for the state of Mississippi. Additionally, agricultural producer participants were not completely representative of the population of producers in Mississippi in terms of demographic characteristics. Also, the focus groups for the agricultural producers were only held with producers predominantly involved with row crop production and the dairy industry. Another issue with generalizability is that these focus groups were held during the COVID-19 pandemic, which contributed to participant perceptions that the younger generation of people had opioid problems. The pandemic could have also deterred potential participants from attending the focus groups since they were held in person. Second, due to the small community of agricultural producers and University ANR Extension agents, some of the participants did know each other before the focus groups were conducted. Thus, the focus group participants could have been hesitant to share sensitive information in the presence of people they worked with or knew socially.
Future iterations of this research should be held in different locations across the country to assess if the themes found in these focus groups are present outside of Mississippi. Different results could be observed if focus groups were held with producers involved in other commodities, such as beef cattle, poultry, or timber. Another future direction for this research would be to include different subsets of agricultural industry participants as focus group participants. Since younger farm workers were perceived to have issues with opioids in this study, holding focus groups with this group could support the themes found here. Additionally, other qualitative methods such as one-on-one interviews might offer a greater level of anonymity and, thus, an increased willingness to share personal and/or sensitive information with researchers that would not otherwise be obtained in a group setting.
Lastly, it is important to reiterate that this study’s findings are based on perceptions expressed by the focus group participants. An objective quantitative examination of opioid misuse within the farming community in Mississippi could yield conflicting results. Based on the themes presented here, future research should consider how rates of opioid misuse and prescriptions vary between different groups within the agricultural industry.
Acknowledgments
The authors would like to thank Taylor Szasz Green and Je’Kylynn S. Steen for their assistance in collecting the data for this study.
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