JMIR Publications

ABSTRACT

The opioid epidemic has ravaged rural communities in the United States. Despite extensive literature relating the physical environment to substance use in urban areas, little is known about the role of the physical environment on the opioid epidemic in rural areas. We examined the reliability of Google Earth to collect data on the physical environment related to substance use in rural areas. Systematic virtual audits were performed in five rural Kentucky counties using Google Earth between 2017 and 2018 to capture land use, health care facilities, entertainment venues and businesses. In-person audits were performed for a subset of the census blocks. We captured 533 features, most of which were images taken before 2015 (72%). Reliability between the virtual auditors and the gold standard was high for health care facilities (>83%), entertainment venues (>95%) and businesses (>61%), but poor for land use features (>18%). Reliability between the virtual audit and in-person audit was high for health care facilities (83%) and entertainment venues (62%) but was poor for land use (0%) and businesses (12.5%). Poor reliability for land use features may reflect difficulty characterizing features that require judgement, or natural changes in the environment that are not reflective of the Google Earth imagery because it was captured earlier years before the audit was performed. Virtual Google Earth audits were an efficient way to collect rich neighborhood data that are generally not available from other sources. However, these audits should use caution when the images in the observation area are dated.