{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T02:46:17Z","timestamp":1784169977918,"version":"3.55.0"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100021336","name":"Office of Minority Health","doi-asserted-by":"publisher","award":["CPIMP221346"],"award-info":[{"award-number":["CPIMP221346"]}],"id":[{"id":"10.13039\/100021336","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec017\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Opioid overdose deaths pose a serious public health concern in the United States, with disproportionately higher rates of increase among Black Americans despite expanded naloxone access. Improving community knowledge and confidence in naloxone use may be critical to reducing these disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec018\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study assessed individual- and community-level factors associated with knowledge and perceived competency in managing opioid overdose and administering naloxone among urban Indiana residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec019\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A probability-based household survey was conducted between March to May 2023 across eight Indiana zip code areas (N\u2009=\u2009772) with high (&gt; 40%) proportions of Black residents. Multilevel modeling was used to examine individual- and community-level factors associated with opioid overdose knowledge and perceived competency, using adapted items from the Opioid Overdose Knowledge Scale (OOKS) and Opioid Overdose Attitudes Scale (OOAS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec020\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Race, sex, household income, education, time lived in the community, and history of opioid overdose significantly predicted knowledge scores. White participants scored higher (mean 6.65) than Black participants (5.70) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). A significant cross-level interaction was found, with Black residents living in high-poverty areas scoring lower than White counterparts (\u03b2\u2009=\u20091.06,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.039). In contrast, perceived competency was primarily associated with age and personal history of overdose.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec021\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Racial and socioeconomic disparities persist in opioid overdose knowledge, particularly among Black residents in low-income communities. Tailored, culturally responsive education efforts, especially by trusted community members, may help improve overdose response readiness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0328444","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T17:23:52Z","timestamp":1752600232000},"page":"e0328444","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Opioid overdose and naloxone administration knowledge and perceived competency in a probability sample of Indiana urban communities with large Black populations"],"prefix":"10.1371","volume":"20","author":[{"given":"Shin Hyung","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Agley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vatsla","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7065-7089","authenticated-orcid":true,"given":"Francesca","family":"Williamson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengyue","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1972-6237","authenticated-orcid":true,"given":"Dong-Chul","family":"Seo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"issue":"02","key":"pone.0328444.ref001","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4236\/fmar.2023.112003","article-title":"Manner of Death and Fentanyl Related Drug Overdose Trends in Marion County, Indiana, US from 2018 to 2021","volume":"11","author":"L Carter","year":"2023","journal-title":"Foren Med Anat Res"},{"key":"pone.0328444.ref002","volume-title":"Drug Overdose Death in the Unisted States 2002-2022","author":"NCfHS. 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National Institute on Drug Abuse (NIDA)","author":"NIH. NIoH","year":"2022"},{"issue":"3","key":"pone.0328444.ref011","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1080\/02791072.2018.1430409","article-title":"From peers to lay bystanders: findings from a decade of naloxone distribution in Pittsburgh, PA","volume":"50","author":"AS Bennett","year":"2018","journal-title":"J Psychoactive Drugs"},{"key":"pone.0328444.ref012","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.drugpo.2017.11.017","article-title":"Identifying gaps in the implementation of naloxone programs for laypersons in the United States","volume":"52","author":"BH Lambdin","year":"2018","journal-title":"Int J Drug Policy"},{"issue":"6","key":"pone.0328444.ref013","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1007\/s11524-020-00439-5","article-title":"Racial disparities in overdose prevention among people who inject drugs","volume":"97","author":"L Dayton","year":"2020","journal-title":"J Urban Health"},{"issue":"8","key":"pone.0328444.ref014","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1111\/add.16478","article-title":"Inequities in naloxone administration among fatal overdose decedents by race and ethnicity in Pennsylvania, 2019-21","volume":"119","author":"E Takemoto","year":"2024","journal-title":"Addiction"},{"key":"pone.0328444.ref015","doi-asserted-by":"crossref","first-page":"107658","DOI":"10.1016\/j.drugalcdep.2019.107658","article-title":"Racial differences in overdose events and polydrug detection in Indianapolis, Indiana","volume":"206","author":"B Ray","year":"2020","journal-title":"Drug Alcohol Depend"},{"issue":"8","key":"pone.0328444.ref016","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.2105\/AJPH.2021.306306a","article-title":"The effect of overdose education and naloxone distribution: an umbrella review of systematic reviews","volume":"111","author":"A Razaghizad","year":"2021","journal-title":"Am J Public Health"},{"issue":"1","key":"pone.0328444.ref017","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/add.15163","article-title":"Systematic review of the emerging literature on the effectiveness of naloxone access laws in the United States","volume":"116","author":"R Smart","year":"2021","journal-title":"Addiction"},{"key":"pone.0328444.ref018","unstructured":"(FDA) USFDA. FDA Approves First Over-the-Counter Naloxone Nasal Spray 2023."},{"key":"pone.0328444.ref019","unstructured":"Recovery N. Progress Report. The Indiana State Government. 2023."},{"issue":"12","key":"pone.0328444.ref020","doi-asserted-by":"crossref","DOI":"10.2196\/22411","article-title":"Reasons people who use opioids do not accept or carry no-cost naloxone: qualitative interview study","volume":"4","author":"AS Bennett","year":"2020","journal-title":"JMIR Form Res"},{"issue":"3","key":"pone.0328444.ref021","first-page":"16","article-title":"Layperson knowledge and perceived barriers with obtaining naloxone","volume":"70","author":"J Courtney","year":"2023","journal-title":"J Contemp Pharm Pract"},{"issue":"1","key":"pone.0328444.ref022","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12954-022-00606-8","article-title":"Harm reduction in the Heartland: public knowledge and beliefs about naloxone in Nebraska, USA","volume":"19","author":"A Schlosser","year":"2022","journal-title":"Harm Reduct J"},{"key":"pone.0328444.ref023","volume-title":"Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys","author":"AAPOR. TAAfPOR","year":"2023"},{"key":"pone.0328444.ref024","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.drugalcdep.2013.02.007","article-title":"Development of Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales for take-home naloxone training evaluation","volume":"132","author":"AV Williams","year":"2013","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"pone.0328444.ref025","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1207\/S15327752JPA8001_18","article-title":"Starting at the beginning: an introduction to coefficient alpha and internal consistency","volume":"80","author":"DL Streiner","year":"2003","journal-title":"J Pers Assess"},{"key":"pone.0328444.ref026","first-page":"1279","article-title":"The use of Cronbach\u2019s alpha when developing and reporting research instruments in science education","volume":"48","author":"T KS","year":"2018","journal-title":"Res Sci Educ"},{"issue":"7","key":"pone.0328444.ref027","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1001\/jama.2021.13304","article-title":"Updated guidance on the reporting of race and ethnicity in medical and science journals","volume":"326","author":"Committee AMAMoS","year":"2021","journal-title":"JAMA"},{"issue":"1","key":"pone.0328444.ref028","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1186\/2193-1801-2-222","article-title":"Principled missing data methods for researchers","volume":"2","author":"Y Dong","year":"2013","journal-title":"Springerplus"},{"key":"pone.0328444.ref029","doi-asserted-by":"crossref","DOI":"10.1002\/9781119013563","volume-title":"Statistical Analysis with Missing Data","author":"RJA Little","year":"2002"},{"issue":"4","key":"pone.0328444.ref030","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/s12529-014-9452-0","article-title":"Does the relationship between cigarette smoking and other key health behaviors vary by geographic area Among US young adults? A multilevel analysis","volume":"22","author":"CG Lee","year":"2015","journal-title":"Int J Behav Med"},{"key":"pone.0328444.ref031","author":"Team RC","year":"2023"},{"key":"pone.0328444.ref032","doi-asserted-by":"crossref","first-page":"102718","DOI":"10.1016\/j.drugpo.2020.102718","article-title":"A descriptive study of racial and ethnic differences of drug overdoses and naloxone administration in Pennsylvania","volume":"78","author":"GE Barboza","year":"2020","journal-title":"Int J Drug Policy"},{"issue":"1","key":"pone.0328444.ref033","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12954-023-00736-7","article-title":"Racial\/ethnic disparities in opioid overdose prevention: comparison of the naloxone care cascade in White, Latinx, and Black people who use opioids in New York City","volume":"20","author":"MR Khan","year":"2023","journal-title":"Harm Reduct J"},{"key":"pone.0328444.ref034","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.drugpo.2019.09.008","article-title":"Barriers to naloxone use and acceptance among opioid users, first responders, and emergency department providers in New Hampshire, USA","volume":"74","author":"S Bessen","year":"2019","journal-title":"Int J Drug Policy"},{"issue":"3","key":"pone.0328444.ref035","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1177\/00220426221133024","article-title":"Experiences administering naloxone among people in different social roles: people who use opioids and family members and friends","volume":"53","author":"AA Urmanche","year":"2023","journal-title":"J Drug Issues"},{"issue":"6","key":"pone.0328444.ref036","doi-asserted-by":"crossref","first-page":"171","DOI":"10.3390\/pharmacy10060171","article-title":"Public perceptions of community pharmacy-based naloxone services: a national cross-sectional survey","volume":"10","author":"LA Hohmann","year":"2022","journal-title":"Pharmacy (Basel)"},{"key":"pone.0328444.ref037","doi-asserted-by":"crossref","first-page":"102374","DOI":"10.1016\/j.pmedr.2023.102374","article-title":"Overdose education and naloxone distribution program design informed by people who use drugs and naloxone distributors","volume":"35","author":"M Enich","year":"2023","journal-title":"Prev Med Rep"},{"key":"pone.0328444.ref038","article-title":"Virtual and remote opioid poisoning education and naloxone distribution programs: a scoping review","author":"B Dos Santos","year":"2023","journal-title":"medRxiv"},{"key":"pone.0328444.ref039","doi-asserted-by":"crossref","first-page":"102376","DOI":"10.1016\/j.healthplace.2020.102376","article-title":"\u201cWe know the streets:\u201d race, place, and the politics of harm reduction","volume":"64","author":"J Owczarzak","year":"2020","journal-title":"Health Place"},{"issue":"1","key":"pone.0328444.ref040","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12954-019-0352-0","article-title":"Preventing opioid overdose with peer-administered naloxone: findings from a rural state","volume":"17","author":"BL Hanson","year":"2020","journal-title":"Harm Reduct J"},{"issue":"4","key":"pone.0328444.ref041","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1111\/add.14510","article-title":"How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies","volume":"114","author":"J Neale","year":"2019","journal-title":"Addiction"},{"issue":"1","key":"pone.0328444.ref042","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1186\/s12954-023-00894-8","article-title":"\u201cThat\u2019s why we\u2019re speaking up today\u201d: exploring barriers to overdose fatality prevention in Indianapolis\u2019 Black community with semi-structured interviews","volume":"20","author":"D-C Seo","year":"2023","journal-title":"Harm Reduct J"},{"key":"pone.0328444.ref043","unstructured":"SAMHSA. SAaMHSA. Substance Abuse and Mental Health Services Administration: The Opioid Crisis and the Black\/African American Population: An Urgent Issue. 2020."},{"key":"pone.0328444.ref044","doi-asserted-by":"crossref","DOI":"10.2105\/AJPH.2022.306807","article-title":"The crucial role of Black, Latinx, and Indigenous leadership in harm reduction and addiction treatment","volume":"112","author":"M Hughes","year":"2022","journal-title":"Am J Public Health"},{"issue":"4","key":"pone.0328444.ref045","first-page":"424","article-title":"Increasing naloxone distribution in Black Communities: a case study","volume":"116","author":"TJ Winhusen","year":"2024","journal-title":"J Natl Med Assoc"},{"issue":"3","key":"pone.0328444.ref046","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0230127","article-title":"Fatal overdose prevention and experience with naloxone: a cross-sectional study from a community-based cohort of people who inject drugs in Baltimore, Maryland","volume":"15","author":"M Buresh","year":"2020","journal-title":"PLoS One"},{"issue":"1","key":"pone.0328444.ref047","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1007\/s10900-023-01257-x","article-title":"Naloxone knowledge and attitudes towards overdose response among family members of people who misuse opioids","volume":"49","author":"SM Resko","year":"2024","journal-title":"J Commun Health"},{"key":"pone.0328444.ref048","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13690-020-00402-5","article-title":"The influence of education on health: an empirical assessment of OECD countries for the period 1995-2015","volume":"78","author":"V Raghupathi","year":"2020","journal-title":"Arch Public Health"},{"issue":"3","key":"pone.0328444.ref049","article-title":"Social determinants, health literacy, and disparities: intersections and controversies","volume":"5","author":"D Schillinger","year":"2021","journal-title":"Health Lit Res Pract"},{"issue":"1","key":"pone.0328444.ref050","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1080\/07370016.2018.1404832","article-title":"Barriers to Health Care Access for Low Income Families: A Review of Literature","volume":"35","author":"M Lazar","year":"2018","journal-title":"J Commun Health Nurs"},{"key":"pone.0328444.ref051","article-title":"Factors associated with gaps in naloxone knowledge: evidence from a 2022 Great Plains survey","author":"S Cooper-Ohm","year":"2023","journal-title":"Res Sq"},{"issue":"2","key":"pone.0328444.ref052","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s11524-022-00706-7","article-title":"Mechanisms to Improve Health Through Community Land Trusts","volume":"100","author":"J Rose","year":"2023","journal-title":"J Urban Health"},{"key":"pone.0328444.ref053","article-title":"Racial\/Ethnic differences in receipt of naloxone distributed by opioid overdose prevention programs in New York City","author":"S Nolen","year":"2023","journal-title":"Res Sq"},{"key":"pone.0328444.ref054","doi-asserted-by":"crossref","first-page":"108034","DOI":"10.1016\/j.ypmed.2024.108034","article-title":"Reducing perceived barriers to scaling up overdose education and naloxone distribution and medications for opioid use disorder in the United States in the HEALing (Helping End Addiction Long-Term\u00ae) communities study","volume":"185","author":"HK Knudsen","year":"2024","journal-title":"Prev Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0328444","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T17:24:06Z","timestamp":1752600246000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0328444"}},"subtitle":[],"editor":[{"given":"Junghwan","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":54,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0328444","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.11.06.24316851","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]}}}