Alcohol Use Among Rural Middle School Students: Adolescents,Parents, Teachers,and Community Leaders’ Perceptions*

BACKGROUND: Although rural adolescents use of alcohol is at some of the highest rates nationally, rural adolescent alcohol use has not been studied extensively. This study examines how community attitudes and behaviors are related to adolescent drinking in rural environments. METHODS: Data were gathered in 22 rural communities in the Upper Midwest (North Dakota, South Dakota, Wisconsin, and Wyoming). Surveys were collected from 1424 rural sixth‐ to eighth‐grade adolescents and 790 adults, including parents, teachers, and community leaders. Census data were also collected. RESULTS: Drinkers differed from nondrinkers by the following factors: higher perceptions of peer, parental, and overall community drinking, as well as lower levels of parental closeness and religiosity. Factors distinguishing binge and nonbinge drinkers were increased drinking to reduce stress, drinking to fit in, perceptions of peer drinking, and perceived lack of alternatives to drinking. Parents were significantly less likely to perceive adolescent alcohol use as a problem than other community adults; school officials were most likely to perceive it as a problem. Parental perceptions were also the least correlated to actual adolescent use, while adolescent perceptions were the most highly correlated. CONCLUSIONS: Community fac tors such as overall prevalence of drinking, community support, and controls against drinking are important predictors of reported use in early adolescence. School officials were more likely to view adolescent alcohol use as a problem than were parents. School officials’ perceptions of adolescent use were also more related to actual adolescent use than were parental perceptions of adolescent use.     

Community influences on adolescents' use of home-brewed alcohol in rural South Africa

ABSTRACT: BACKGROUND: Alcohol represents a major public health challenge in South Africa, however little is known about the correlates of alcohol use among rural adolescents. This article examines community influences on adolescents' use of home-brewed alcohol in a rural region of South Africa. METHOD: A total of 1600 high school adolescents between 11 and 16 years of age participated in this study. Seven hundred and forty (46.3 %) were female and 795 (49.7 %) were male. Data on gender were missing for 65 students (4.0 % of the sample). The age range was 11--29 years (mean age 16.4 years; Standard deviation = 2.79).A survey questionnaire on adolescent risk behavior that examined adolescents' use of alcohol and various potential community influences on alcohol use was administered. Factor analysis was used to group community-level variables into factors. Multiple logistic regression techniques were then used to examine associations between these community factors and adolescents' use of home-brewed alcohol. RESULTS: The factor analysis yielded five community-level factors that accounted for almost two-thirds of the variance in home-brewed alcohol use. These factors related to subjective adult norms around substance use in the community, negative opinions about one's neighborhood, perceived levels of adult antisocial behavior in the community, community affirmations of adolescents, and perceived levels of crime and violence in the community (derelict neighborhood). In the logistic regression model, community affirmation was negatively associated with the use of home-brew, whereas higher scores on "derelict neighborhood" and "adult antisocial behavior" were associated with greater odds of drinking home-brew. CONCLUSION: Findings highlight community influences on alcohol use among rural adolescents in South Africa. Feeling affirmed and valued by the broader community appears to protect adolescents against early alcohol use. In contrast, perceptions of high levels of adult anti-social behavior and crime and violence in the community are significant risks for early alcohol initiation. Implications of these findings for the prevention of alcohol use among adolescents in rural communities are discussed.     

Perceived barriers to exercise among adolescents

In this study, the authors identify differences in barriers to exercise among high school students (n = 236) according to gender and self-reported levels of physical activity. Major barriers to exercise were "time constraints," "unsuitable weather," "school and schoolwork," and "lack of interest or desire." Univariate ANOVAs revealed adolescent males had significantly higher scores than females for "use of alcohol and drugs" and "having a girlfriend," while "time constraints" was a significantly greater barrier to exercise among females. Discriminant analyses indicated the barriers of "having a girlfriend" and "use of alcohol and drugs" also distinguished highly active males from highly active females. Results are discussed and suggestions are offered concerning how to reduce perceived barriers to exercise among adolescents.     

Gender Differences in the Perceived Needs and Barriers of Youth Offenders Preparing for Community Reentry

This study explored how gender differences may influence the community reentry experiences of incarcerated youth. Structured surveys assessing risk factors for re-offending, perceived reentry needs, and anticipated barriers to meeting these needs were administered to a convenience sample of males (n = 36) and females (n = 35) who were within 60 days of release from two probation camps in Southern California. Bivariate analyses found significant gender differences in prior risk factors, educational aspirations, expressed mental health needs, anticipated use of services, and reentry concerns. Minimal gender differences were detected in perceived employment needs and barriers and self-efficacy to avoid recidivism. The findings support the need for gender-specific reentry programming in some key areas and also draw attention to the importance of removing barriers to successful reentry for all incarcerated youth.     

Home and community-based services for well educated older caregivers: gender differences in attitudes, barriers, and use.

Using a sample of 169 well educated, relatively affluent older caregivers, we examined gender differences in attitudes about home and community-based services, service use, interest in services, and barriers to service use. We found significant gender differences in two attitudinal dimensions: preference for informal care and acceptance of government services. A higher proportion of men than women would rather use community services than ask family for help. A larger percentage of women than men believed the government should provide more services. Service use was modest. On average, caregivers were about 5 times more likely to express interest in a service than to have used one. Findings suggest that greater outreach by providers may usefully address service barriers.     

Provider,Patient, and Family Perspectives of Adolescent Alcohol Use and Treatment in Rural Settings

Purpose: We examined rural primary care providers’ (PCPs) self‐reported practices of screening, brief interventions, and referral to treatment (SBIRT) on adolescent alcohol use and examined PCPs’, adolescents’, and parents’ attitudes regarding SBIRT on adolescent alcohol use in rural clinic settings. Methods: In 2007, we mailed surveys that inquired about alcohol‐related knowledge, attitudes, and treatment practices of adolescent alcohol use to all PCPs in 8 counties in rural Pennsylvania who may have treated adolescents. We then conducted 7 focus groups of PCPs and their staffs (n = 3), adolescents (n = 2), and parents (n = 2) and analyzed the narratives using structured grounded theory, evaluating for consistent or discordant themes. Results: Twenty‐seven PCPs from 7 counties returned the survey. While 92% of PCPs felt that routine screening for alcohol use should begin by age 14, 84% reportedly screened for alcohol use occasionally, and reportedly 32% screened all adolescent patients. The provider focus groups (n = 20 PCPs/staff) related that SBIRT for alcohol use for adolescents was not currently effective. Poor provider training, lack of alcohol screening tools, and lack of referral treatment options were identified barriers. Adolescents (n = 12) worried that physicians would not maintain confidentiality. Parents (n = 12) acknowledged a parental contribution to adolescent alcohol use. All groups indicated computer‐based methods to screen for alcohol use among adolescents may facilitate PCP engagement. Conclusions: Despite awareness that rural adolescent alcohol use is a significant problem, PCPs, adolescents, and parents recognize that SBIRT for adolescent alcohol use in rural PCP settings is ineffective, but it may improve with computer‐based screening and intervention techniques.     

Gender differences in the prediction of condom use among incarcerated juvenile offenders: testing the information-motivation-behavior skills (IMB) model

PurposeTo validate the predictive value of the Information-Motivation-Behavioral Skills (IMB) model of human immunodeficiency virus (HIV) prevention for sexually active juvenile offenders and to explore gender differences in IMB model constructs for condom-protected vaginal intercourse.MethodsSelf-report measures of acquired immune deficiency syndrome (AIDS) knowledge, pro-condom peer influence, risk perception, condom attitudes, condom use self-efficacy, frequency of vaginal intercourse, and frequency condom-protected vaginal intercourse were collected from predominantly African-American adolescent detainees. Analysis consisted of structural equation models for the combined sample (N = 523) and for separate gender groups (328 males and 195 females).ResultsIn the combined model, condom use was significantly predicted by male gender, peer influence, positive condom attitudes, and condom self-efficacy. In separate gender analyses, condom use among adolescent males was predicted by peer influence (modestly) and by positive condom attitudes, whereas condom use among females was predicted by peer influence, self-efficacy, and condom attitudes. Compared with males, females reported significantly greater knowledge, less peer influence, higher perceived risk for infection, more positive condom attitudes, and more self-efficacy, but they reported less condom use.ConclusionsFemales may find it difficult to use condoms consistently despite their awareness of their efficacy. Power imbalances or other dynamics operating in their relationships with males need further exploration. Gender differences in the relationship between condom self-efficacy and condom use were masked in the analysis of the total sample, indicating the value of testing theories of HIV prevention separately by gender.     

Peer Attitudes Effects on Adolescent Substance Use: The Moderating Role of Race and Gender

We examined the relationship between adolescents’ perceptions of their close friends’ attitudes about substance use, and their own use of cigarettes, alcohol, and marijuana. Using data from the 2010 National Survey on Drug Use and Health, a multistage area probability sample sponsored by the Substance Abuse and Mental Health Services Administration (n?=?17,865), we tested the direct and moderating effects of subgroups of race and gender on perceptions of adolescents’ close friends on past month substance use. Significant effects were found on peer attitudes influencing substance use for all race and gender subgroups. Close friends’ attitudes of indifference were associated with increased substance use and disapproval associated with reduced use, controlling for age, income, family structure, and adolescents’ own attitudes of risk of substance use. Significant moderating effects of peer attitudes on cigarette and marijuana use were found for both gender and race moderators. Conditional effects of the moderation by race were also examined for gender subgroups. The moderating effect of race on close friends’ attitudes impacting cigarette and marijuana use was stronger in magnitude and significance for females compared to males. Female marijuana and cigarette use was more influenced by close friends’ attitudes than males, and whites were more influenced by their close friends than Hispanics and blacks. White females are more susceptible to close friends’ attitudes on cigarette use as compared to white males and youth of other races. Implications for socially oriented preventive interventions are discussed.     

Community and Team Member Factors that Influence the Early Phase Functioning of Community Prevention Teams: The PROSPER Project

This research examines the early development of community teams in a specific university-community partnership project called PROSPER (Spoth et al., Prev Sci 5:31-39, 2004). PROSPER supports local community teams in rural areas and small towns to implement evidence-based programs intended to support positive youth development and reduce early substance use. The study evaluated 14 community teams and included longitudinal data from 108 team members. Specifically, it examined how community demographics and team member characteristics, perceptions, and attitudes at initial team formation were related to local team functioning 6 months later, when teams were planning for prevention program implementation. Findings indicate that community demographics (poverty), perceived community readiness, characteristics of local team members (previous collaborative experience) and attitudes toward prevention played a substantial role in predicting the quality of community team functioning 6 months later. EDITORS' STRATEGIC IMPLICATIONS: The authors identify barriers to successful long-term implementation of prevention programs and add to a small, but important, longitudinal research knowledge base related to community coalitions.     

Differences in tobacco assessment and intervention practices: a regional snapshot

BACKGROUND: This research describes tobacco attitudes and practices of health care providers in the Upper Midwest. A baseline measure of preventive practices by providers was needed to plan effective tobacco intervention education programs. METHODS: Health care providers in a 16-county region received a mailed survey regarding tobacco assessment practices, intervention practices, attitudes, skills/knowledge, barriers, and desire for tobacco education. The survey was sent to all chiropractors, dentists, nurse practitioners/physician assistants, physicians (primary care and specialist), and public health nurses in the region. A total of 51.9% (n = 614) of all providers returned usable surveys. RESULTS: Significant differences were found between provider groups on all measured concepts. Primary care physicians, nurse practitioners/physician assistants, and public health nurses were more likely than specialist physicians, dentists, and chiropractors to assess, intervene, be supportive of tobacco cessation, have skills/knowledge about cessation, perceive fewer barriers, and want further education. CONCLUSIONS: In this region, provider groups differed in tobacco use assessment and treatment. All provider groups desired education regarding tobacco intervention. Region-wide tobacco cessation educational initiatives need to take into account differences between provider groups.     

Increasing the report of alcohol use among low-income pregnant women

PURPOSE: To increase the report of prenatal alcohol use in a community setting. METHODS: A self-administered alcohol screening tool was developed and introduced at 12 randomly selected sites that administer the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). A matched sample of 12 WIC sites continued to use the existing verbal standard of care for assessing alcohol use. RESULTS: Rates of reported prenatal alcohol consumption at the 12 WIC intervention sites were compared with rates at 12 control WIC sites using a repeated-measures analysis of variance (ANOVA) and independent-samples t-tests. Within 8 months of study commencement, rates of reported prenatal alcohol consumption were significantly higher at the intervention sites than at the control sites. DISCUSSION: Use of a brief, self-administered screening tool in the WIC setting significantly increased reports of prenatal alcohol use, a key first step in the reduction of prenatal alcohol use. The WIC setting represents an excellent place to address the significant public health issue of prenatal alcohol exposure.     

Correlates of Temperate and Intemperate Attitudes Toward Alcohol Use

The relationship between alcohol attitudes and the personality variables of locus of control and authoritarianism was investigated for a sample of 791 high school students. Authoritarianism was negatively related to indiscriminate attitudes and positively related to responsible attitudes toward alcohol use for both males and females. The locus of control dimension correlated with alcohol attitudes for females only. The findings provide information useful in the identification of adolescents at risk for problematic drinking.     

Rurality,Region, Ethnic Community Make‐Up and Alcohol Use Among Rural Youth

Purpose: As the most widely used substance among adolescents in the United States, alcohol remains a critical public health issue. The majority of research in this area has focused on individual‐level variables. This study examined the contextual effects of rurality, geographic region, and community ethnicity in the prediction of alcohol use among adolescent youth. Method: Participants were 7th‐12th grade students from a sample of 260 rural communities across the United States, with oversampling for predominantly Mexican American and African American communities. The total sample comprised 213,225 students. Multilevel modeling was used to estimate both individual and contextual effects for use of alcohol and getting drunk. Findings: Those living in more rural communities were somewhat more likely to have used alcohol and gotten drunk than their less rural counterparts. Consistent with a trend toward a narrowing gender gap across a number of substances, gender differences in alcohol use were not large, except in the South. A minority in a community, eg, a white student in an African American community, had greater risk for alcohol use and getting drunk. Conclusions: Models of alcohol use among rural youth that include only individual‐level variables are likely to result in misleading results. While students from varying levels of rurality may not differ substantially from one another, geographic region and minority status within communities are likely to interact with individual‐level variables, resulting in unique patterns of alcohol use and getting drunk.     

Exploring the relationship between premarital sex and cigarette/alcohol use among college students in Taiwan: a cohort study

ABSTRACT: BACKGROUND: Cigarette/alcohol use and premarital sex, and their subsequent consequences on the well-being of college students, are international health promotion issues. However, little is known about the temporal relationship of these risk behaviors among Taiwanese college students. METHODS: This study utilizes data from the Taiwan Youth Project, a cohort sample of 20-year-olds (N=2,119) with a 2-year follow-up, to explore the relationship between adolescent cigarette/alcohol use, and subsequent premarital sex. To incorporate the Taiwanese context where the normative value of abstinence until marriage remains strong, multivariate logistic regression models included data on premarital sex attitudes, stressful life events, peer influence, as well as family and individual factors which might influence this relationship. RESULTS: The sample consists of 49% male and 51% female college students. About 16% of the sample report having had premarital sex by age 20. After excluding sexually active youth, 20% of males and 13% of females report engaging in premarital sex in the 2-year follow-up interview. Multivariate logistic regression analyses reveal adolescent alcohol use is significantly associated with a higher likelihood of engaging in premarital sex for both genders; adolescent smoking is significantly associated with premarital sexual activity among males, but not females. Our results indicate liberal premarital sexual attitudes and stressful personal events are also significantly associated with premarital sexual activity. CONCLUSIONS: These findings suggest health promotion programs for college students need to take developmental and gender perspectives into account. Future research to incorporate a broader, multi-cultural context into risk reduction materials is recommended.     

The health belief model and HIV risk behaviours: A causal model analysis among Anglos,African‐Americans and Mexican‐Americans∗

A causal model of the Health Belief Model (HBM) is empirically evaluated which emphasizes possible indirect paths linking distal demographic and seriousness/susceptibility variables to HIV risk behaviours among Anglo, African‐American, and Mexican‐American adults. A specific focus of the paper is upon alcohol‐related expectancies (anticipation of disinhibitory effects of alcohol upon sexual behavior) as a ‘barrier’ to preventive behaviours. Ethnic comparisons stem both from the paucity of available research on the HBM in minority populations and from recent questions regarding the applicability of rational models such as the HBM among minority groups. Analyses of data from a community sample of 1390 adults indicate relatively consistent direct effects of barriers for males and benefits for females upon HIV risk behaviors. The analyses suggest distinct paths operative among males and females. The susceptibility‐barriers‐risk behaviours path among males may suggest that alcohol‐related expectancies (barriers in this model) may be more strongly related to risk behaviours among males than minority females.     

Rural women's perceptions of community prenatal care systems: an empowerment strategy

Rural U.S. women often experience many barriers to prenatal care involving health care provider shortages, distance to health care, and less health insurance coverage as compared to urban women. Fewer community planning and consumer resources as well as less transportation also often decrease opportunities for rural women to participate in community health planning and assessment. The purpose of this article is to describe social work strategies for empowering rural women in their assessment of community prenatal care systems. A case study of a rural demonstration project addressing prenatal care barriers is presented as well as implications for social work practice.     

Exploring differences in caseloads of rural and urban healthcare providers in Alaska and New Mexico

OBJECTIVES: Although it is commonly accepted that rural healthcare providers face demands that are both qualitatively and quantitatively different from those faced by urban providers, this conclusion is based largely on data from healthcare consumers and relies on qualitative work with small sample sizes, surveys with small sample sizes, theoretical reviews and anecdotal reports. To enhance our knowledge of the demands faced by rural healthcare providers and to gain the perspectives of healthcare providers themselves, this study explored the caseloads of rural providers compared with those of urban providers. METHOD: An extensive survey of over 1500 licensed clinicians across eight physical and behavioural healthcare provider groups in Alaska and New Mexico was undertaken to explore differences in caseloads based on community size (small rural, rural, small urban, urban), state (Alaska, New Mexico) and discipline (health, behavioural). RESULTS: Findings indicated numerous caseload differences between community sizes that were consistent across both states, with complex case presentations being described most commonly by small rural and rural providers. Substance abuse, alcohol use, cultural diversity, economic disadvantage and age diversity were issues faced more often by providers in rural and small rural communities than by providers in small urban and urban communities. Rural, but not small rural, providers faced challenges around work with prisoners and individuals needing involuntary hospitalization. Although some state and discipline differences were noted, the most important findings were based on community size. CONCLUSIONS: The findings of this study have important implications for provider preparation and training, future research, tailored resource allocation, public health policy, and efforts to prevent 'burnout' of rural providers.     

Primary care physicians' perceptions of barriers to preventive reproductive health care in rural communities

CONTEXT: Women residing in rural areas are less likely than urban women to receive preventive reproductive health care, but reasons for this disparity remain largely unexplored. METHODS: In 2010, semistructured interviews were conducted with 19 rural primary care physicians in central Pennsylvania regarding their experiences in two domains of preventive reproductive health—contraceptive care and preconception care. Major themes were identified using a modified grounded theory approach. RESULTS: Physicians perceived that they had a greater role in providing contraceptive care than did nonrural physicians and that contraceptives were widely accessible to patients in their communities; however, the scope of contraceptive services they provided varied widely. Participants were aware of the importance of optimal health prior to pregnancy, but most did not routinely initiate preconception counseling. Physicians perceived rural community norms of unintended pregnancies, large families, and indifference toward career and educational goals for young women as the biggest barriers to both contraceptive and preconception care, as these attitudes resulted in a lack of patient interest in family planning. Lack of time and resources were identified as additional barriers to providing preconception care. CONCLUSIONS: Rural women’s low use of contraceptive and preconception care services may reflect that preventive reproductive health care is not a priority in rural communities, rather than that it is inaccessible. Efforts to motivate rural women to engage in reproductive life planning, including more proactive counseling by providers, merit examination as ways to improve use of services.