Ruth W. Edwards, Ph.D.
Tri-Ethnic Center for Prevention Research
Colorado State University
Overall, nonmetropolitan 12th graders are somewhat less likely to have tried marijuana and LSD and to be current drug users than their urban counterparts. Differences in drug use between nonmetropolitan and metropolitan areas, however, have decreased over the past decade nationwide. Prevalence rates for alcohol use are similar in nonmetropolitan and metropolitan communities, but nonmetropolitan 12th graders report more problems from their use of alcohol than do metropolitan students. Nonmetropolitan 12th graders are more likely to report using alcohol while "driving around" than are metropolitan 12th graders - a situation that greatly increases the risks from alcohol consumption, especially when combined with high speeds on often poorly lit and poorly marked country roads. Nonmetropolitan communities vary widely in the patterns and levels of drug use among their youth. Therefore, assessment must be conducted at the community level to plan and use prevention and intervention resources effectively and efficiently.
Contrary to the stereotype of rural areas as idyllic, protected environments in which to raise families - which many people still believe - in rural communities in general, substance use is as great a problem as it is in the cities. However, rural communities vary considerably, which complicates our understanding of rural substance use problems and increases the need for prevention, intervention, and treatment programs tailored to individual rural community needs.
The primary purpose of this paper is to present data in an objective manner on the prevalence of alcohol and other drug use by 8th and 12th grade rural adolescents based on a national sample and to compare these prevalence rates to rates found in metropolitan areas at both the national and regional levels. Although practitioners and program professionals working in rural areas have known for some time that significant substance use problems exist among youth in rural areas, they have largely relied upon anecdotal data to substantiate their beliefs. Unfortunately, in these times of dwindling resources for community-based prevention and treatment programs, anecdotal data - while often emotionally compelling - is not sufficient to convince policymakers at the state and federal levels of the need for resources to address the unique needs of rural communities. Hard data are required on rates of use and associated problems. This paper will address the extreme variation in substance use patterns from one community to another, which makes it difficult to describe rural drug use, and will discuss the implications of these differences relative to the design and implementation of prevention and treatment programs. In addition, the paper will present and discuss data showing that alcohol use presents more problems for rural youth than for urban youth.
Most national database studies that compare rural and urban areas show that the once considerable rural-urban gap in the rates of alcohol and other drug use is closing. Over the past decade, declines in substance use - particularly alcohol use - have been sharpest in large cities, according to the NIDA-funded study, Monitoring the Future, conducted by the University of Michigan (Johnston, O'Malley, & Bachman, 1992). Thirty-day prevalence rates of alcohol use by 12th graders in large cities dropped from 78 percent in 1980 to 53 percent in 1991, a decrease of 25 percentage points. In nonmetropolitan areas, however, the decrease was only 17 percentage points, from 69 percent in 1980 to 52 percent in 1991 (Johnston et al., 1992).
The data presented in this paper are from the American Drug and Alcohol Survey (ADAS) database (Oetting, Beauvais, & Edwards, 1985; Oetting & Beauvais, 1990), a commercially available, school-based drug and alcohol survey. Although the ADAS database represents a sample of convenience, it includes over 225,000 students each year from more than 200 communities with wide geographic dispersion across the United States. Evidence suggests that the ADAS database is representative of the country as a whole; drug use rates reported in the ADAS database closely approximate those found each year in the grades covered by Monitoring the Future (Johnston, O'Malley, & Bachman, 1993), which uses stratified random sampling (Oetting & Beauvais, 1990).
For the purposes of the analyses presented in this paper, schools in the database were classified as "nonmetropolitan" or "metropolitan" based on the United States Department of Agriculture (USDA) metropolitan proximity index. It should be noted, however, that the "metropolitan" data in the ADAS database are predominantly from communities of less than 500,000 and should not be considered representative of the largest cities in the U.S. (for details on larger communities, see Johnston et al., 1993). Data on metropolitan/nonmetropolitan differences are reported for the most recent time period available, the 1992-93 school year. For regional comparisons, data have been aggregated over 1991-93 in order to have sufficient numbers of both metropolitan and nonmetropolitan communities in each region for meaningful analyses.
Lifetime prevalence data - responses to questions such as "Have you ever tried marijuana?" - are useful to gauge a given population's exposure to drugs, but these data are not generally useful in determining current levels of use; whether a drug has been used in the last month is more useful for this purpose. Use in the last month also is generally preferred because it more accurately reflects ongoing substance use, rather than one-time experimentation. Neither of these prevalence rates, however, gives us a clear idea of the frequency or patterns in which drugs are used. To obtain this information, the ADAS report uses a total drug involvement score based on frequency, type, and combinations of drugs used. Daily or almost daily use of a substance is considered high involvement, infrequent but recent use is moderate involvement, and single-time or infrequent use with no use in the past month or no use ever is low involvement. This score makes it possible to separate youth who are heavily involved in drug use from those who have recently experimented with one or more drugs, but who have not yet become heavily involved in drug use. This distinction is important for planning and evaluating drug prevention and intervention programs.
Generalized prevention programs delivered in school or through the media are effective mostly in discouraging further use by occasional drug users and encouraging youth who have not tried drugs to maintain their abstinence.
Unfortunately, youth who are heavily involved in the use of one or more drugs, including alcohol, are less likely to change their behavior due to such programs. Indeed, generally speaking, in communities where appropriate school-based prevention programs have been conscientiously implemented, little reduction occurs in the high involvement group, but substantial reduction often occurs in the moderate involvement group from one year to the next (Oetting & Beauvais, 1990). Youth who are heavily involved with drugs need more intensive, targeted, and often one-on-one intervention to decrease their drug use. The success or lack of success of programs should be gauged by change or lack of change in the behavior of youth who are the realistic targets of these programs. Such programs should not be regarded as failures if they do not reach youth heavily involved with drugs.
Lifetime Prevalence. Lifetime prevalence rates for the use of alcohol, tobacco, and other drugs by 8th and 12th graders in both nonmetropolitan and metropolitan communities are presented in Table 1. Rates of alcohol use among students and of students who have been drunk are very similar for metropolitan and nonmetropolitan communities. For marijuana and LSD, however, the percentage of 12th grade students who have tried marijuana and LSD is significantly higher for the metropolitan communities than it is for the nonmetropolitan communities. Smokeless tobacco use is significantly higher in nonmetropolitan areas for both 8th and 12th graders than it is in metropolitan communities.
8th Grade 12th Grade
Ever Tried Nonmetro Metro Nonmetro Metro
Alcohol 70.3% 71.3% 90.2% 90.2%
Gotten drunk 27.3% 25.7% 69.6% 69.6%
Marijuana 11.2% 12.7% 30.3% 40.3%**
Stimulants 5.5% 5.2% 12.8% 11.2%
Cocaine 2.3% 2.6% 5.7% 6.8%
Crack 2.0% 2.4% 2.7% 2.3%
Inhalants 14.7% 15.3% 11.5% 11.9%
Legal Stimulants 2.2% 2.1% 4.7% 5.8%
LSD 3.4% 3.89% 7.7% 12.4%**
Cigarettes 45.7% 46.5% 63.1% 63.0%
Smokeless Tobacco 25.1% 19.0%** 39.7% 32.5%**
# of Communities 96 69 96 71
*p<.05; **p<.01; ***p<.001
Data are community averages from the 1992-93 database of the
American Drug and Alcohol Survey.
Last Month Prevalence. Reported use of alcohol, tobacco, and other drugs in the month prior to administration of the survey is presented in Table 2. Consistent with the lifetime prevalence data, there is little difference in use of most drugs except marijuana and LSD, for which use by 8th and 12th graders in metropolitan areas is higher than it is among nonmetropolitan youth. Again, smokeless tobacco use is much more prevalent among nonmetropolitan youth, with one in ten nonmetropolitan 12th graders reporting daily use. Females are generally less likely to report frequent use of smokeless tobacco than males, so the number of males reporting daily usage probably is closer to one in five.
8th Grade 12th Grade
Ever Tried Nonmetro Metro Nonmetro Metro
Alcohol 26.2% 28.6%* 54.4% 56.6%
Gotten drunk 9.1% 9.1% 35.1% 36.7%
Marijuana 4.6% 4.6% 10.4% 18.7%**
Stimulants 1.9% 1.9% 3.8% 2.5%
Cocaine 0.7% 0.7% 1.9% 1.5%
Crack 0.5% 0.5% 0.6% 0.5%
Inhalants 5.1% 5.3% 1.7% 1.8%
Legal stimulants 0.4% 0.3% 0.5% 0.5%
LSD 1.0% 1.6%** 2.3% 3.6%**
Cigarettes daily 8.8% 9.3% 18.5% 21.8%
Smokeless Tobacco 3.8% 2.7% 10.1% 5.3%**
daily use
# of Communities 96 69 96 71
*p<.05; **p<.01; ***p<.001
Data are community averages from the 1992-93 database of the
American Drug and Alcohol Survey.
Drug Involvement Prevalence. Table 3 shows levels of drug involvement for both nonmetropolitan and metropolitan youth. Significantly more metropolitan 12th graders are involved with drugs than nonmetropolitan 12th graders, with greater marijuana use being a major factor in this difference. The reader should notice that at the 12th grade level about one out of every seven youth report high drug involvement. As mentioned above, these youth generally need intensive intervention and will not be affected by broad-based prevention programs.
8th Grade 12th Grade
Nonmetro Metro Nonmetro Metro
Multi-drug users 1.5% 1.7% 2.9% 3.8%
Stimulant users 0.4% 0.4% 1.1% 1.2%
Heavy marijuana users 0.1% 0.2% 0.6% 1.8%**
Heavy alcohol users 0.1% 1.3% 9.7% 9.3%
Total High Involvement 3.5% 3.6% 14.3% 16.1%*
Occasional drug users 9.4% 9.6% 6.9% 7.1%
Light marijuana users 2.5% 3.0% 6.5% 11.3%**
Total Moderate
Involvement 11.9% 12.6% 13.4% 18.4%*
Drug experimenters 10.7% 11.1% 14.1% 14.4%
Light alcohol users 13.0% 13.8% 24.7% 20.3%*
Negligible or no use 60.9% 58.9% 33.5% 30.8%
Total Low Involvement 84.6% 83.8% 72.3% 65.5%*
# of Communities 96 69 96 71
*p<.05; **p.01; ***p<.001
Data are community averages from the 1992-93 database of the
American Drug and Alcohol Survey.
Alcohol Use. Alcohol is the most frequently used substance by all ages across all regions, which is not surprising given the prevalence of alcohol use among adults in our society. The data indicate the percentage of students reporting that they have tried alcohol and the percentage reporting that they have gotten drunk. In the analyses of drug involvement, frequency of getting drunk rather than frequency of alcohol use serves to distinguish problem use from partaking of alcohol as part of a religious ritual or having a few sips of alcohol in a family setting. As can be seen in Table 4, alcohol use varies little across regions or between metropolitan and nonmetropolitan communities, although nonmetropolitan 8th graders in the South are somewhat more likely to report having ever gotten drunk and having been drunk recently than nonmetropolitan 8th graders in other regions. Overall, 8th graders in the Midwest have a slightly lower rate of having gotten drunk than their counterparts in other regions, but the differences virtually disappear by the 12th grade. Both metropolitan and nonmetropolitan youth in the Northeast are more likely to have tried alcohol and to have used it recently than youth in other regions. (See Table 5.) While the prevalence of "getting drunk" is not higher in the Northeast than in other regions at the 8th grade level, it is higher by the 12th grade.
West
8th 12th
Ever Tried Non-metro Metro Non-metro Metro
Alcohol 69.5% 67.2% 91.6% 91.2%
Gotten drunk 26.4% 27.5% 70.6% 71.2%
Marijuanas 10.4% 16.6% 30.0% 46.7%
Stimulants 4.9% 5.3%* 10.6% 13.2%
Cocaine 2.3% 3.8% 5.7% 10.0%**
Crack 1.9% 2.3% 1.6% 2.1%
Inhalants 14.2% 14.9% 10.4% 12.3%
Legal Stimulants 2.0% 2.2% 4.2% 5.6%
LSD 3.6% 3.9% 9.0% 16.3%*
Cigarettes 43.6% 43.9% 57.9% 63.3%
Smokeless tobacco 24.9% 17.5% 40.7% 32.5%
# of communities 44 20 42 20
Midwest
8th 12th
Ever Tried Non-metro Metro Non-metro Metro
Alcohol 68.2% 71.5% 91.2% 88.6%
Gotten drunk 24.5% 25.8% 69.7% 67.7%
Marijuana 9.6% 11.7% 30.0% 38.0%**
Stimulants 6.1% 5.8% 14.8% 12.9%
Cocaine 2.1% 2.8% 4.7% 6.9%
Crack 1.9% 2.6% 1.8% 3.2%
Inhalants 14.7% 17.6% 12.0% 10.8%
Legal stimulants 2.4% 2.2% 7.7% 6.6%
LSD 2.9% 3.5% 7.5% 11.0%*
Cigarettes 44.6% 49.9%* 66.3% 62.3%
Smokeless tobacco 23.6% 17.4%* 40.6% 29.6%**
# of communities 61 38 61 41
Table 4 (cont'd):
Northeast
8th 12th
Ever Tried Non-metro Metro Non-metro Metro
Alcohol 73.3% 75.4% 93.4% 93.2%
Gotten drunk 26.0% 26.4% 68.9% 71.6%
Marijuana 9.4% 10.0% 34.4% 40.0%
Stimulants 4.0% 3.8% 10.3% 7.2%
Cocaine 2.4% 2.8% 4.9% 6.9%
Crack 1.8% 2.5% 1.7% 2.1%
Inhalants 12.2% 15.2% 10.2% 9.9%
Legal stimulants 1.8% 2.3% 3.8% 5.1%
LSD 3.2% 3.9% 8.5% 12.1%
Cigarettes 43.7% 45.0% 62.2% 64.4%
Smokeless tobacco 18.0% 16.3% 33.6% 28.9%
# of communities 15 47 14 56
South
8th 12th
Ever Tried Non-metro Metro Non-metro Metro
Alcohol 67.5% 67.4% 88.4% 90.0%
Gotten drunk 30.6% 27.7% 69.7% 68.8%
Marijuana 14.8% 12.2% 36.8% 37.1%
Stimulants 6.4% 6.9% 13.3% 15.1%
Cocaine 3.1% 2.6% 7.3% 7.3%
Crack 2.2% 2.3% 3.9% 2.9%
Inhalants 17.1% 14.5% 11.3% 13.3%
Legal stimulants 2.6% 3.1% 4.4% 7.3%**
LSD 3.3% 3.5% 9.7% 9.4%
Cigarettes 50.9% 50.2% 63.6% 62.7%
Smokeless tobacco 29.3% 28.0% 36.3% 37.0%
# of communities 35 22 40 21
*p<.05; **p<.01; ***p<.001
Data are community averages from the combined 1991-92 and 1992-93
databases of the American Drug and Alcohol Survey.
West
8th 12th
Used in Last Month Non-metro Metro Non-metro Metro
Alcohol 25.1% 27.7% 53.6% 52.8%
Gotten drunk 8.3% 9.8% 34.0% 31.1%
Marijuana 3.4% 6.6%* 9.1% 19.9%**
Stimulants 1.7% 2.0% 1.8% 2.7%
Cocaine 0.7% 1.3% 1.1% 2.8%**
Crack 0.4% 0.7% 0.3% 0.4%
Inhalants 4.6% 5.4% 1.2% 1.6%
Legal stimulants 0.3% 0.4% 0.4% 0.5%
LSD 3.2% 1.7% 2.1% 3.9%*
Cigarettes 6.5% 6.6% 12.5% 14.8%
Smokeless tobacco 2.3% 1.9% 9.6% 6.4%*
# of communities 44 20 42 20
Midwest
8th 12th
Used in Last Month Non-metro Metro Non-metro Metro
Alcohol 25.7% 26.6% 55.3% 54.2%
Gotten drunk 7.9% 8.1% 33.8% 35.4%
Marijuana 3.1% 3.9% 10.1% 15.9%**
Stimulants 2.2% 2.0% 4.1% 3.9%
Cocaine 0.6% 0.8% 1.1% 2.5%
Crack 0.5% 0.7% 0.4% 1.2%*
Inhalants 5.5% 5.1% 1.9% 1.7%
Legal stimulants 0.4% 0.3% 0.7% 0.7%
LSD 0.9% 1.6%* 2.5% 3.4%
Cigarettes 8.9% 9.6% 21.7% 20.8%
Smokeless tobacco 3.2% 1.8%* 9.2% 5.6%
# of communities 61 38 61 41
Table 5 (cont'd):
Northeast
8th 12th
Used in Last Month Non-metro Metro Non-metro Metro
Alcohol 27.3% 29.8% 55.85% 60.2%
Gotten drunk 7.9% 10.1% 38.6% 38.1%
Marijuana 3.2% 4.4% 15.9% 19.4%
Stimulants 1.6% 2.0% 3.3% 1.5%**
Cocaine 0.9% 1.7% 1.1% 1.3%
Crack 0.5% 1.5% 0.4% 0.3%
Inhalants 3.7% 7.3% 3.5% 1.6%
Legal stimulants 0.2% 1.2% 0.3% 0.3%
LSD 1.2% 2.3% 3.0% 3.5%
Cigarettes 8.7% 8.6% 18.0% 22.3%
Smokeless tobacco 2.0% 1.9% 3.1% 2.8%
# of communities 15 47 14 56
South
8th 12th
Used in Last Month Non-metro Metro Non-metro Metro
Alcohol 25.8% 25.9% 52.3% 53.9%
Gotten drunk 10.7% 9.6% 35.5% 34.8%
Marijuana 5.0% 3.9% 12.3% 11.4%
Stimulants 2.5% 2.9% 4.8% 3.8%
Cocaine 0.9% 0.7% 2.9% 1.6%
Crack 0.6% 0.4% 1.0% 0.8%
Inhalants 5.8% 5.1% 2.3% 2.5%
Legal stimulants 0.4% 0.4% 0.3% 0.9%**
LSD 1.0% 1.3% 1.9% 2.7%
Cigarettes 10.8% 9.5% 22.7% 19.7%
Smokeless tobacco 6.5% 5.8% 9.9% 9.7%
# of communities 35 22 40 21
*p<.05; **p<.01; ***p<.001
Data are community averages from the combined 1991-92 and 1992-93
databases of the American Drug and Alcohol Survey.
Marijuana Use. Metropolitan/nonmetropolitan differences in marijuana use are more pronounced than the differences in alcohol use. Eighth graders in the West and South are more likely to have tried marijuana. While overall rates of recent marijuana use for both nonmetropolitan and metropolitan 8th graders is between 3 and 5 percent generally, metropolitan 8th graders in the West report a rate of 6.6 percent. Western metropolitan 12th graders also report high rates of recent use compared to 12th graders in other regions, while - interestingly - nonmetropolitan 12th graders in the West report the lowest rates. For the West, where rural communities are often more than one hundred miles from a major metropolitan area and marijuana is not easily cultivated in the predominantly arid climate, lack of supply of marijuana may be the major factor in the lower rural rates. Nonmetropolitan/metropolitan differences in marijuana use also are pronounced for 12th graders in the Midwest.
Inhalant Use. Before 1989, marijuana was the most frequently tried drug other than alcohol among 8th grade students. However, since that time, inhalants have overtaken marijuana and they now are the drug of choice for 8th graders nationwide (Edwards, 1994). Inhalants may be replacing marijuana as the "gateway" drug, at least in part because they are inexpensive and easily accessible. Unlike other drug use rates, reported inhalant use rates are higher at the 8th grade level than at the 12th grade level. This finding seems to run counter to logic, since a lifetime prevalence measure - which is cumulative - generally would be assumed to increase across grades, just as it does for marijuana use.
Why does this prediction not hold true for inhalants? There are probably many reasons, but one of the more likely reasons is the effect of the number of dropouts on 12th grade prevalence measures. Inhalant use is generally associated with poverty and low opportunity conditions, both of which are associated with high dropout rates. Youth who use inhalants in 8th grade are more likely to drop out of school, making them unavailable for in-school surveys in 12th grade. In addition, as youth grow older they may forget casual inhalant use at a young age; they may be reluctant to report having tried them, since inhalants are not a "glamour" drug; or they may redefine in their own minds casual experimentation as "not really using." A third and unfortunately likely factor is that a real increase in inhalant use among younger children has taken place in recent years, and in the future this increased use will be reflected in higher reported rates of having tried inhalants at older ages.
Although the nonmetropolitan/metropolitan differences in inhalant use are not significant for either age in any of the four regions, there are variations in patterns across regions. In the Midwest, metropolitan 8th graders are more likely than nonmetropolitan youth to have tried inhalants, although there is a negligible difference in current use, while in the South it is the nonmetropolitan 8th graders who are more likely than their metropolitan counterparts to have tried inhalants.
In general, the data show somewhat higher lifetime prevalence for most drugs in metropolitan areas than in nonmetropolitan communities at both the 8th and 12th grade levels across regions, but these differences are not large. While in the West, Midwest, and Northeast lifetime prevalence of cocaine use is higher among metropolitan 12th graders than among nonmetropolitan 12th graders, this difference is most pronounced in the West, where 10 percent of metropolitan 12th graders report having tried cocaine compared to less than 6 percent of nonmetropolitan 12th graders. Again, while there are no significant nonmetropolitan/metropolitan differences by grade or region, stimulant use is generally reported more frequently by 12th graders in the South than in the other regions, with somewhat more use in metropolitan communities. LSD use is generally more frequent in metropolitan communities than in nonmetropolitan communities across regions, with the greatest differences in the West and Midwest but almost no difference in the South. Reported rates of tobacco use differ by the form in which the tobacco is used. Rates of smokeless tobacco use are higher in nonmetropolitan areas, except in the South where there is virtually no difference in rates by community size. Cigarette use varies little from nonmetropolitan to metropolitan communities across regions, but it does vary by region. Youth in the West are significantly less likely to be ongoing cigarette users than youth in other regions.
As discussed above, it is difficult to assess the true nature of substance use problems among youth as individuals, in a single community, regionally, or nationally simply by looking at lifetime and recent use prevalence figures for individual drugs. Exploring patterns of drug use, including multidrug use, frequency of use, and intensity of use, is necessary to understanding the severity of the impact that drug use is having on any given individual or group. Across regions, the highest level of drug involvement for 12th graders is found among Midwestern metropolitan youth, with a rate of over 16 percent identified as having high drug involvement. (See Table 6.) For all regions except the South, the general pattern is for higher involvement in metropolitan communities than for nonmetropolitan communities. In the South, the percentage of youth in the high drug involvement group is higher overall than in other regions, with nonmetropolitan youth more drug-involved than metropolitan youth.
TABLE 6: Drug Involvement by Grade, Community Size, and Region
West
8th 12th
Used in Last Month Non-metro Metro Non-metro Metro
Multi-drug users 1.6% 2.1% 1.7% 4.0%**
Stimulant users 0.3% 0.5% 0.8% 1.9%**
Heavy marijuana users 0.1% 0.3%* 0.6% 1.3%
Heavy alcohol users 1.4% 1.4% 9.8% 6.2%
Total High Involvement 3.4% 4.3% 12.9% 13.4%**
Occasional drug users 8.5% 9.4% 5.5% 7.2%
Light marijuana users 2.0% 4.4%* 6.0% 13.9%**
Total Moderate Involvement 10.5% 13.8% 11.5% 21.1%
Drug experimenters 11.6% 11.7% 16.6% 19.2%
Light alcohol users 12.6% 11.9% 26.0% 18.3%**
Negligible or no use 61.9% 58.3% 33.0% 28.0%
Total Low Involvement 86.1% 81.9%* 75.6% 65.5%**
# of Communities 44 20 42 20
Midwest
8th 12th
Used in Last Month Non-metro Metro Non-metro Metro
Multi-drug users 1.5% 1.7% 2.5% 3.9%
Stimulant users 0.4% 0.5% 1.1% 1.4%
Heavy marijuana users 0.0% 0.1%* 0.5% 0.8%
Heavy alcohol users 1.3% 1.0% 9.7% 10.2%
Total High Involvement 3.2% 3.3% 13.8% 16.3%*
Occasional drug users 9.0% 8.7% 7.4% 7.4%
Light marijuana users 1.8% 2.5% 6.4% 8.3%*
Total Moderate Involvement 10.8% 11.2% 13.8% 15.7%
Drug experimenters 10.2% 15.1%* 13.2% 14.6%
Light alcohol users 13.4% 13.4% 26.4% 20.4%*
Negligible or no use 62.4% 57.0%* 32.8% 33.0%
Total Low Involvement 86.0% 85.5% 72.4% 68.0%
# of Communities 61 38 61 41
Table 6 (cont'd):
Northeast
8th 12th
Used in Last Month Non-metro Metro Non-metro Metro
Multi-drug users 1.6% 2.2% 2.4% 3.5%
Stimulant users 0.3% 0.2% 1.4% 0.7%*
Heavy marijuana users 0.1% 0.1% 1.2% 2.0%
Heavy alcohol users 0.9% 1.1% 6.8% 9.2%
Total High Involvement 2.9% 3.6% 11.8% 15.4%
Occasional drug users 8.6% 10.2% 7.3% 5.9%
Light marijuana users 2.3% 2.2% 11.9% 13.4%
Total Moderate Involvement 10.9% 12.4% 19.2% 19.3%
Drug experimenters 9.5% 8.4% 12.0% 12.8%
Light alcohol users 15.8% 14.9% 23.3% 23.5%
Negligible or no use 60.9% 60.7% 33.7% 29.0%
Total Low Involvement 86.2% 84.0% 69.0% 65.3%
# of Communities 15 47 14 56
South
8th 12th
Used in Last Month Non-metro Metro Non-metro Metro
Multi-drug users 1.8% 1.9% 4.5% 3.4%
Stimulant users 0.5% 0.5% 1.2% 1.4%
Heavy marijuana users 0.2% 0.1% 0.5% 0.8%
Heavy alcohol users 1.9% 1.5% 9.9% 8.5%
Total High Involvement 4.4% 4.0% 16.1% 14.1%
Occasional drug users 9.7% 9.5% 7.7% 8.8%
Light marijuana users 3.4% 2.2%* 7.1% 5.7%
Total Moderate Involvement 13.1% 11.7% 14.8% 14.5%
Drug experimenters 11.1% 10.3% 15.9% 18.9%
Light alcohol users 11.7% 12.6% 19.0% 20.4%
Negligible or no use 59.7% 61.4% 34.2% 32.1%
Total Low Involvement 82.5% 84.3% 69.1% 71.4%
# of Communities 35 22 40 21
*p<.05; **p<.01; ***p<.001
Data are community averages from the combined 1991-92 and 1992-93
databases of the American Drug and Alcohol Survey.
What do the statistics presented thus far mean for an individual rural community? (1) Rural communities are as vulnerable to substance use and abuse as their metropolitan counterparts (nonmetropolitan involvement rates tend to run with metropolitan rates, for most drugs). (2) Nonmetropolitan involvement rates at the 8th grade level are very similar to metropolitan involvement rates among 8th graders. This correlation suggests that prevention and intervention programs need to begin at much earlier grade levels. There is very high variability from one community to another in the degree of drug involvement, what drugs are used most, whether younger or older students are more involved with alcohol and other drugs, and the stability of substance use patterns over time. While national or regional statistics can be vital for calling attention to the fact that rural areas are not immune from substance use problems and that state and federal resources must be allocated to deal with these problems, each individual community must assess its own problem in order to target the limited resources available. A good, well-implemented, districtwide, basic drug prevention program may show positive outcomes in larger communities, because the program will likely have some elements that affect one or more of the various subgroups across the range of their populations. But rural areas cannot afford simply to take a shotgun approach. If a community has an unusually high rate of inhalant use in the 8th grade, for example, a single prevention program that touches only on inhalant abuse probably will have little or no effect on the community's major problem. It is crucial that, in such circumstances, prevention strategies focus on the multiple contributing factors of inhalant abuse. The entire community - including students, parents, schools, law enforcement, business people, and others - must understand the full range of substance abuse issues confronting the community.
To illustrate variability between communities, Table 7 shows two Midwestern communities that are within 150 miles of each other, both with populations of fewer than 5,000, in counties that are nonmetropolitan. Community A clearly has a more serious substance use problem among its youth than does Community B. One in four 12th graders in Community A are using marijuana. Hallucinogen use also is unusually high, with one in four 12th graders having tried them and one in ten having used them recently. Perhaps most striking is that in Community A, even at the 8th grade level, only about half of the students still are essentially drug-free, compared with approximately three-fourths of their counterparts in Community B. By 12th grade, only one in five students in Community A is drug-free, compared with almost half of the students in Community B.
TABLE 7: Nonmetropolitan Community Variability
Community Community Community Community
A B A B
7-8th 8th 12th 12th
Grade Grade Grade Grade
Ever Tried
Alcohol 69.0% 65.0% 92.0% 80.0%
Marijuana 21.0% 8.0% 46.0% 8.0%
Stimulants 9.0% 5.0% 36.0% 14.0%
Inhalants 21.0% 11.0% 18.0% 14.0%
Hallucinogens 7.0% 2.0% 23.0% 4.0%
Used in Last Month
Alcohol 34.0% 21.0% 73.0% 40.0%
Marijuana 9.0% 3.0% 26.0% 4.0%
Stimulants 4.0% 3.0% 5.0% 4.0%
Inhalants 11.0% 5.0% 3.0% 6.0%
Hallucinogens 3.0% 1.0% 10.0% 2.0%
High Drug Involvement
Multi-drug users 4.5% 1.9% 5.1% 3.8%
Stimulant users 0.9% 0.0% 0.0% 1.9%
Heavy marijuana users 0.0% 0.0% 0.0% 0.0%
Heavy alcohol users 1.8% 0.0% 12.8% 3.8%
Moderate Drug Involvement
Occasional drug users 10.8% 6.7% 12.8% 5.8%
Light marijuana users 6.3% 1.9% 15.4% 1.9%
Low Drug Involvement
Tried a drug 11.7% 8.7% 15.4% 7.7%
Light alcohol users 9.0% 10.6% 20.5% 28.8%
Neglible or no use 55.0% 70.2% 18.0% 46.3%
Data are from two Midwestern communities with populations less than
5,000. The American Drug and Alcohol Survey, 1992-93.
Clearly, Community A needs immediate intervention and communitywide measures to cope with substance use by their youth. In addition to school-based programs that emphasize the risks and problems of marijuana and LSD use, Community A should consider implementing town forums to educate parents and community members about the extent of drug use in the community and the factors affecting it, increasing law enforcement efforts relative to drug trafficking, and increasing supervised activities for youth outside of school hours.
While levels of use of alcohol may not differ from nonmetropolitan to metropolitan communities, the often low-density population and geographic isolation of nonmetropolitan communities generally means that young people spend more time in cars in these communities than do their metropolitan counterparts. Distances that must be traveled to school, entertainment events, or friends' homes are more likely to be greater for nonmetropolitan youth than for metropolitan youth. Not only is alcohol use more likely to be followed by either driving a car or riding with a friend who has also been drinking, but for nonmetropolitan youth more alcohol use takes place while driving. Figure 1 shows locations where both metropolitan and nonmetropolitan 12th graders report using alcohol. Metropolitan and nonmetropolitan youth do not generally differ significantly in where they use alcohol, except in one very important setting - while driving. Four out of ten nonmetropolitan 12th graders report using alcohol "while driving around," as opposed to only one in four metropolitan 12th graders. The danger of this behavior is obvious and is frequently exacerbated by high-speed driving over country roads that are often unlit and poorly marked.
One of the questions on the American Drug and Alcohol Survey asks what problems the student has had in connection with alcohol use. Responses of 12th graders to this question are shown in Figure 2, comparing metropolitan with nonmetropolitan youth. The striking feature of this figure is that, while in general rates of alcohol use are similar for all types of problems, nonmetropolitan 12th graders report at least as many or more problems from their alcohol use than do their metropolitan counterparts. They report significantly higher rates of "money problems" and, although the frequency in both groups is low, a significantly higher incidence of car accidents associated with alcohol use. The somewhat higher frequency of problems may be an indication that, although the frequency with which they get drunk is not significantly greater than that of metropolitan youth, nonmetropolitan youth may be drinking more at any given time, thus leading to more severe problems.
One key to understanding substance use of all kinds and related problem behaviors is the concept of the peer cluster. Peer clusters are groups ranging in size from two young people who are best friends to larger groups of similar-aged youth who spend their leisure time together and have a great deal of influence on one another. The phrase "peer cluster" is used instead of "peer group" because the latter can refer to both tightly knit groups as well as larger collections of adolescents, such as the freshman class in a high school. A peer cluster consists of the subgroup of the peer group with whom the adolescent spends significant time and identifies closely. Generally, when we speak of peer pressure, we are implying an element of passivity, assuming that youth are unable to resist the influence of others. Within the concept of a peer cluster, peer pressure is seen as mutually derived and reinforced behavior. Within the peer cluster, members decide to engage in specific types of behavior and to hold certain attitudes - such as what to wear and whether or not it is acceptable to get drunk. This way of looking at the social grouping of youth assumes that each youth is actively making choices and contributing to the characterization of the peer cluster. For example, substance users are actively involved in choosing to agree with the input of some peers and to resist the influence of others.
A plethora of studies of substance use have found a clear and direct link between substance use and associating with peers who model and reinforce drug using attitudes and behavior. Conversely, adolescents who abstain or have low involvement with drugs are in peer clusters where drug using behaviors and attitudes are discouraged. Research based on the American Drug and Alcohol Survey (Oetting & Beauvais, 1986) as well as other studies indicate that peer clusters are the most important link to explaining substance use among both nonmetropolitan and metropolitan youth, regardless of region. Other factors commonly associated with substance use, including family, church, and school, primarily have their effect on drug use indirectly by influencing the type of peer cluster with which the adolescent associates.
The stereotype of rural youth holds that they are more likely than urban youth to grow up in communities where family, church, and school increase the chances of associating with peer clusters that discourage (or at least do not encourage) substance use and other deviant behaviors. The data presented in this chapter suggest otherwise. The changing face of rural communities has affected both the potency and character of the influence that these three institutions have on youth.
The smaller scale of rural communities means that rural youth have a smaller pool of peers from which to select. It is not always possible for youth who would prefer to abstain from any substance use to choose only friends who share this attitude. One or two youth introducing use of a particular substance at a party can have a major effect on the prevalence of use communitywide. In a small community, it is likely that only one party is going on over a particular weekend, and a large number of youth of a particular age group are likely to be present. While use of substances can be isolated within small subgroups of the population in urban areas, rural areas may have more generalized exposure. Keeping in mind that the peer cluster is the most potent force in determining the prevalence of substance use, the different dynamics of small communities require different, creative, and community-specific interventions. It is not surprising that rural communities are more likely to show greater fluctuations in levels of adolescent substance use than are urban areas - and that prevention is more challenging.
Edwards, R.W. (1993). Drug use among 8th graders is increasing. The International Journal of the Addictions, 28(14), 1621-23.
Johnston, L.D., O'Malley, P.M., & Bachman, J.G. (1992). Smoking, drinking, and illicit drug use among American secondary school students, college students, and young adults, 1975-1991, volume I: Secondary school students. (NIH Publication No. 93-3481.) Rockville, MD: National Institute on Drug Abuse.
Johnston, L.D., O'Malley, P.M., & Bachman, J.G. (1993). National survey results on drug use from monitoring the future study, 1975-1992, volume I: Secondary students. (NIH Publication No. 93-3597.) Rockville, MD: National Institute on Drug Abuse.
Lobao, L. (1990). Locality and inequity: Farm and industry structure and socioeconomic conditions. Albany, NY: The State University Press of New York.
Oetting, E.R., & Beauvais, F. (1986). Peer cluster theory: Drugs and the adolescent. Journal of Counseling and Development, 65(1), 17-22.
Oetting, E.R., & Beauvais, F. (1990). Adolescent drug use: Findings of national and local surveys. Journal of Consulting and Clinical Psychology, 58(4), 385-394.
Oetting, E.R., Beauvais, F., & Edwards, R.W. (1985). The American drug and alcohol survey. Ft. Collins, CO: Rocky Mountain Behavioral Science Institute, Inc.
Copyright © 1994:
Midwest Regional Center for
Drug-Free Schools & Communities
North Central
Regional Educational Laboratory
Contact:info@ncrel.org
Posted on March 31, 1995
URL: http://www.ncrel.org/sdrs/areas/issues/envrnmnt/drugfree/v1edward.htm