Rural Americans are preoccupied with the problems of opioid and drug addiction in their communities, citing it as a worry on par with concerns about local jobs and the economy, according to a new poll from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.
"For many years, the opioid crisis was seen as affecting only a few states — West Virginia, Kentucky and New Hampshire among others. But it never was just about those states," says poll co-director Robert J. Blendon, a professor of public health and health policy at Harvard. "It's now at the same level of a very serious economic plight that people are really worried about. It affects elections, and it affects how people elected from rural areas view their priorities."
Nearly equal proportions cited drug addiction or abuse (including opioids) and economic concerns as the biggest problems facing their local communities.
The difference between these two biggest problems was not statistically significant nationally.
But rural residents of Appalachia cited drug addiction or abuse, including opioids, as the biggest problem in their communities much more frequently (41 percent) than did adults in other rural areas.
Optimism about the future
Even as opioids and drug addiction have risen to essentially the same level of economic concerns, our poll shows clearly that rural America is far from a monolith. In fact, the poll also finds strong strains of optimism about the future in rural America.
Eight in 10 rural Americans said they feel their lives are turning out either as they expected (42 percent) or better (41 percent). Only 15 percent said things are worse than they thought they would be.
A majority (54 percent) said they are better off financially when compared with their parents at the same age, and a majority of rural parents (55 percent) said they think their children will be better off financially compared with themselves.
"Rural Americans are optimistic about the future, and they're also optimistic that things can be done to pull them out of the economic problems that they do face," says Blendon.
One reason: While some rural communities are truly suffering, others are thriving, says Christopher Thornberg, founding partner of Beacon Economics.
"Let's take two kinds of rural communities. You might have a coal town and an oil town," Thornberg says. "The coal town is doing terrible because coal can't compete in this era of cheap natural gas. On the other hand, because of fracking, these rural communities sitting on shale oil are booming and incomes are up dramatically."
Akail Powell's experience bears that out. He's a 24-year-old truck driver in Grenada, Miss., a town of about 14,000 people. The town has problems with drugs, he says, but the economy is growing.
"Grenada is almost like a thriving town, starting to expand farther," he says. "And bigger restaurants are being put here and in the last two years we have really developed."
Economic and health concerns
Still, when asked to name the biggest problem facing their family, as opposed to their community, people cited financial problems most frequently, followed by health or health care concerns. No other issues were mentioned by more than 5 percent of respondents.
An overwhelming majority nationwide said the problem of people being addicted to opioids in their local community has either gotten worse (48 percent) or remained about the same (40 percent) in the past five years.
White rural Americans are more worried about a worsening opioid problem than are other racial and ethnic groups. They were more likely (52 percent) than African-Americans (32 percent) and Latinos (30 percent) to say the opioid problem in their local community has gotten worse over the past five years. And younger rural Americans of all races and ethnicities were significantly more likely to say they know someone who has struggled with opioid addiction: Among those 18 to 49 years old, 59 percent said they knew someone, compared with 42 percent of older rural Americans.
And while there is optimism about the future, there is also plenty of negativity among rural Americans about the state of their local economy. When asked to rate the economy of the region where they live and work, a majority (55 percent) rated their local economy as only fair or poor.
Rural Americans said that providing opportunities through long-term job growth and better public schooling would be the most beneficial solutions. They also reported high job satisfaction, but a significant share said they believe it will be important for them to get new training or skills to keep their job or find a better job in the future.
Retaining young people has always been a concern in rural America. The poll finds that 4 in 10 parents (43 percent) with children over 18 said their children have moved out of their local community (not including time spent away at trade school, college or the military). An additional 16 percent said some of their children have moved and some have stayed.
Of those parents whose children have moved, 61 percent said they moved to a city, followed by 17 percent who said their children moved to a suburb and 21 percent who said their children moved to another rural area.
About half (52 percent) of parents whose adult children have moved away from their community said their children moved away for a job somewhere else, while 13 percent said their children had a hard time finding a good long-term job in their local community. More than one-third of younger rural Americans (36 percent) said the overall number of good jobs in their local community has increased over the past five years, compared with 25 percent of older rural Americans.
A feeling of community
Why do people stay? About one-third (31 percent) of respondents said it is because their family is there. Most rural Americans (81 percent) said they feel attached to their local community, and they identify its closeness as one of its biggest strengths. They also said life in a small town and being around good people are their community's biggest strengths.
Will the problems that they do see be solved in the next five years? Half said they are confident they will be solved, but rural Americans largely see a need for outside help to solve them.
Among this latter group, a majority think the government — federal, state and local — will play a major role in solving these problems. Three in 10 rural Americans who said they need outside help to solve major community problems said it will be the state that plays the greatest role.
Overall, most rural Americans said that minority groups do not face discrimination in their local community, but there are significant exceptions. Substantial numbers said they see discrimination against certain groups: 30 percent said they think transgender people are discriminated against in their community; 29 percent said recent immigrants to the U.S. are; and 27 percent said gays and lesbians are. Significantly fewer rural Americans said that whites (9 percent), Asian-Americans (10 percent) or disabled people (12 percent) are discriminated against in their local community.
Despite rural Americans' low general recognition of discrimination, rural adults belonging to minority groups are much more likely to identify discrimination against members of their own group. For example, only 21 percent of all rural Americans said they believed Latinos are generally discriminated against in their local community, yet 44 percent of Latinos living in rural areas said they did.
The survey was conducted June 6-Aug. 4 among a nationally representative, probability-based telephone (cellular and landline) sample of 1,300 adults age 18 or older living in the rural United States. Interviews were conducted in English and Spanish. The margin of error for total respondents is 3.6 percentage points at the 95 percent confidence level. The sample of rural Americans is defined in this survey as adults living in areas that are not part of a metropolitan statistical area, following the definition used in the 2016 National Exit Poll, conducted by Edison Research for a consortium of ABC News, The Associated Press, CBSNews, CNN, Fox News and NBC News.
The audio version of this story mischaracterizes the NPR poll by saying it was limited to rural voters. The poll surveyed a representative sample of all rural Americans.
RACHEL MARTIN, HOST:
Drug addiction and the economy - according to a new poll, that is what is on the minds of rural voters as they go to the polls this election season. The poll was done by NPR, the Robert Wood Johnson Foundation and Harvard's T.H. Chan School of Public Health. But NPR's Alison Kodjak reports that even with those real challenges, many rural Americans are optimistic about the future.
ALISON KODJAK, BYLINE: If you want a picture of the troubles that face some rural communities, you can call Brenda, a self-described homemaker from the heart of Appalachia. She's 57 and married to a former coal miner.
BRENDA: He's suffering with black lung and having a real hard time breathing, so it was time for him to come out anyway.
KODJAK: And drug addiction has hit her family - especially her two grandsons - hard.
BRENDA: My daughter and her husband have got two sons, and he walked off and left them because he couldn't give up his drug habit.
KODJAK: He's still alive. But some of her other relatives aren't, including her niece.
BRENDA: They found her in her home last September. She was 33 years old, and she left behind three boys.
KODJAK: Brenda - NPR is not using her last name to shield her grandchildren - lives in Coeburn, Va., a town of about 2,000 people near the point where Virginia meets Kentucky and Tennessee. Her experience fits into the findings of our new poll, which shows that in rural America, drug abuse ranks with the economic outlook as residents' top worry. Almost half of rural Americans have been personally affected by the opioid crisis. When we asked if they personally know someone who struggled with addiction, 49 percent said yes. Brenda says it's worse in her community.
BRENDA: If you were to approach 10 families randomly and give them a piece of paper and have, do you have someone in your immediate family on drugs? - 8 out of 10 would say yes.
KODJAK: Brenda says in Coeburn, jobs and opportunities have dried up. State officials have been promising to bring in economic development, but none of it has reached her community yet.
BRENDA: If you come out of college with a degree, you're more than likely going to leave this area to find work.
KODJAK: But experiences in rural America vary widely, and our poll bears that out. The survey of 1,300 adults all living in rural areas shows that many people are optimistic about the future of their communities. Most of the people we surveyed say they're better off financially than their parents, and a majority think their children will do better still. Robert Blendon, professor of health policy and political analysis at the Harvard Chan School, directed our poll.
ROBERT BLENDON: They're optimistic about the future, and they're also optimistic that things can be done to pull them out of these economic problems that they face.
BLENDON: While some rural communities are suffering, others are thriving, says Christopher Thornberg, the founder of Beacon Economics in Los Angeles.
CHRISTOPHER THORNBERG: You might have a coal town and an oil town. Well, the coal town is doing terrible because coal can't compete in this era of cheap natural gas. On the other hand, because of fracking, these rural communities sitting on shale oil are booming. And incomes are up dramatically as a result of all that new money flowing into the region for oil exploration and drilling.
KODJAK: The economy in Grenada, Miss., a city of 14,000 about halfway between Jackson and Memphis, Tenn., is doing well, says Akail Powell.
AKAIL POWELL: There's a lot of job opportunities.
KODJAK: Powell is a 24-year-old truck driver who grew up in Grenada. He says the town has a drug problem, but its economy is growing.
POWELL: It's almost like a thriving town that's starting to expand farther. And bigger restaurants are being put here now. Within the past two years, we have really developed.
KODJAK: And Brenda says she's seeing flickers of hope in Coeburn. The town's high school has a new football coach, and the community has come together to support the players.
BRENDA: You know one of the inflatable helmets that the kids run through? We bought them one of them. It was $2,600. We've refurbished their weight room all in one year. So there's good people. There's good, hardworking people.
KODJAK: Even though sometimes things still look bleak, Brenda says her view of her community is getting better.
Alison Kodjak, NPR News.
[POST-BROADCAST CORRECTION: The audio version of this story mischaracterizes the NPR poll by saying it was limited to rural voters. The poll surveyed a representative sample of all rural Americans.] Transcript provided by NPR, Copyright NPR.