Date of Conferral

11-25-2025

Date of Award

November 2025

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Edward Irobi

Abstract

The opioid crisis in Ohio, driven by fentanyl, persists due to inequitable access to naloxone despite its proven effectiveness. This study examined how socioeconomic status (SES), race/ethnicity, population density, and hospital availability per capita predicted naloxone overdose reversals (dependent variable) in Ohio. Social-ecological theory guided this quantitative historical correlational analysis of Ohio’s Project DAWN index data (N = 5,280). Inclusion criteria included individuals ages 18 to 65 with naloxone-related overdose reversals (dependent), naloxone distribution (moderator), and community factors (independent). Multiple linear regression results showed that SES (p >.50), race/ethnicity (% White, p = .588; % Black, p = .495; % American Indian, p = .682; % Asian, p = .091; % Native Hawaiian, p = .119), and healthcare access (p > .306) were not statistically significant predictors of naloxone overdose reversals. However, population density (p < .015) was significantly associated with naloxone overdose reversals. Naloxone distribution significantly moderates the relationships among household income, population density, and hospital availability per capita, explaining a substantial portion of variance in outcomes. These findings indicate that structural characteristics - particularly population density - play a critical role in predicting naloxone overdose reversals, underscoring the need to tailor distribution strategies to community context. The moderating effect of naloxone access highlights that equitable availability can strengthen overdose response outcomes. Overall, the study highlights the need for community-based naloxone initiatives that advance health equity and positive social change.

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