Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Rachel Vickers-Smith

Committee Member

Dr. April Young

Committee Member

Dr. Jennifer Havens



Aims: To identify demographic, socioeconomic, health and access to resources, and drug use correlates associated with drug selling among adult, people who use drugs (PWUD) in rural Appalachia.

Methods: This cross-sectional study analyzed survey data from the ongoing KyOSK and SNAP projects. The surveys included information on participant characteristics (demographic, socioeconomic), and health and drug use behaviors. Our analysis was restricted to only those who answered the question regarding drug selling (n=738). Both univariate and multivariate logistic regression models were employed to identify correlates of drug selling.

Results: Among 738 participants, 20.6% reported selling or attempting to sell drugs in the past 30 days. In our multivariate analysis, lack of medical care access (AOR 1.61, 95% CI: 1.06-2.43) and polydrug use (AOR 1.36, 95% CI: 1.24-1.49) were significantly associated with drug selling. Moreover, people who sell drugs (PWSD) reported a broader range of substance use compared to people who do not sell drugs (PWDNSD). PWSD reported an average of four different substances used in the past 30 days, whereas PWDNSD reported an average of two different drugs used.

Conclusions: Our study in rural Appalachian Kentucky finds one in five PWUD engaged in drug selling, associated with polydrug use, and limited medical access, challenging assumptions about their distinctiveness. Further research should explore barriers and motivations behind selling, informing targeted interventions for this population.

Available for download on Sunday, April 12, 2026

Included in

Public Health Commons