Impaired Driving Among Rural Appalachian Women in the Year Following Incarceration.

Introduction: Despite the known risks associated with substance use following incarceration, no studies have examined substance-impaired driving as a post-incarceration health risk behavior in rural Appalachia. Purpose: The present study examined differences by impaired driving following incarceration and identified predictors of impaired driving in sample of rural Appalachian women with a history of drug use and risky sex. Methods: Women (N=340) from three rural Appalachian jails completed a baseline interview in jail and follow-up interviews at six and 12 months post-release. Interview questions included demographic characteristics and information on substance use risk, mental health, criminal legal system involvement, and impaired driving. Data were collected from 2012 to 2019. Secondary data analysis performed in 2024 compared women who reported driving impaired during the 12-month follow-up period (n=76) to those who did not (n=257). A multivariable logistic regression was performed to identify predictors of impaired driving. Results: Lifetime arrests, substance use risk, and symptoms of major depressive disorder were associated with impaired driving. The logistic regression model indicated that participants with major depressive disorder symptoms had twice the odds of driving impaired in the year following incarceration. Implications: Almost one-fourth of women in the sample reported driving impaired during the follow-up period, suggesting that impaired driving should be examined as a post-release health risk behavior for rural Appalachian women in future research. Furthermore, study findings highlight an important opportunity for targeted prevention and intervention for women who may experience increased risk as they return to rural Appalachian communities following incarceration.