Youth rural health interventions toolkit

This toolkit was created by members of the Indianhead Community Action Agency (ICAA) in collaboration with academic partners at the Medical College of Wisconsin, and funded in part by the Healthier Wisconsin Partnership Program, a component of the Advancing a Healthier Wisconsin endowment at the Medical College of Wisconsin.

The ICAA is located in Rusk County, Wisconsin, a rural community with limited resources and high rates of poverty, teen substance use, pregnancy, suicide, and other adolescent health risk behaviors. For example, on the Youth Risk Behavior Survey in 2015, approximately 54% of Rusk County 10th graders reported previous and/or current alcohol use, 28% reported previous and/or current cigarette use, and 18% reported previous and/or current marijuana use. Despite prior work within the community, Rusk County youth continued to engage in alcohol, cigarette, and marijuana use far above the national average.

What is substance abuse and why is it important to target in adolescents in rural areas?

Adolescent substance abuse of alcohol, illicit drugs, and tobacco products is widespread and of particular public health concern given that substance abuse during adolescence is associated with increased risk behaviors as well as a high likelihood of continued substance abuse in adulthood. Risk behaviors associated with alcohol use during the teen years include smoking, illicit drug use, mental health problems, and risky sexual behavior (Kulbok and Cox, 2002). Although smoking rates have declined among adolescents, there is recent evidence that adolescent e-cigarette use is associated with increased cigarette smoking later in life (Bunnell et al. 2014). In addition, individuals who report having their first alcoholic drink by age 14 are more than four times as likely to abuse alcohol in adulthood (; Grant & Dawson, 1998).

Consider the following facts:

  • 33% of high school students reported drinking alcohol at least once in the past month, with 18% of those youth reporting engaging in binge drinking, or consuming 5 or more drinks on one occasion (Centers for Disease Control and prevention Youth Risk Behavior Survey (YRBSS), 2015,
  • 17% of youth report having their first alcoholic drink prior to age 13 (CDC, YRBSS, 2015)
  • Approximately 4,300 alcohol-related deaths occur among youth under age 21 every year, most commonly due to motor vehicle and other alcohol-related accidents, homicide, and suicide (Centers for Disease Control and Prevention,
  • Approximately 20% of youth who report first using drugs by age 17 will continue to abuse drugs later in life. For youth who report first using drugs at the age of 13, the number who will continue using into adulthood increases to 30% (Grant & Dawson, 1998).
  • Approximately 21.6 (8.2%) million Americans age 12 or older meet criteria for substance dependence or abuse (Substance Abuse and Mental Health Services Administration, 2012).
  • Nearly 42.1 million of U.S. adults will develop an addiction to tobacco (Jamal et al., 2014); 80% of these adults began smoking by the age of 18 (Department of Health and Human Services, 2012)
  • 45% of high school students report having used electronic vapor products; evidence suggests that e-cigarette use may be a "gateway" to future cigarette use as well as increase risk for adolescents that otherwise would be less susceptible to cigarette use (Willis et al, 2015).

Interventions to prevent adolescent substance use in rural areas are especially important because current research suggests that adolescents in rural communities have higher rates of non-medical prescription drug use, stimulants, methamphetamines, and tobacco products compared to urban youth (Havens, Young, and Havens, 2011; Gfroerer, Larson, and Colliver, 2007). Furthermore, while research demonstrates declining rates of alcohol, substance and tobacco use in urban youth, this same decline is not reflected among rural youth (Gfroerer, Larson, and Colliver, 2007).

Protective factors related to adolescent abstinence from drug and alcohol use

Protective factors relating to substance use abstinence for youth include:

  • Social assertiveness
  • Pro-social behavior/Good social skills
  • Greater parental involvement
  • Community engagement/Positive adult social interactions
  • Greater religiosity
  • Higher emotional competence
  • Commitment to school
  • Greater opportunities for positive involvement in school and the community
    (Kim, Gloppen, et all, 2015; Kim, Oesterle, et al. 2015)

Specifically among adolescents of lower socio-economic status, strong familial attachments, higher engagement in community activities, strong social support, and strong community support are associated with lower tobacco, illicit drug and alcohol use (Hamme-Peterson, Buser, and Westburg, 2010).

Risk factors for adolescent drug and alcohol use

The most salient risk factors for initiation of adolescent substance use include:

  • Parental approval and modeling of drinking and/or drug use
  • Parental permissive attitudes towards alcohol and/or drug use
  • Community modeling of drinking
  • Lower levels of parental support
  • Higher peer use of drugs and alcohol
  • Increased peer delinquent behavior
  • Lower values, expectations, and motivation for academic achievement
  • Lower involvement in extra-curricular activities
  • Prior involvement in delinquent behavior
    (Donovan, 2004).
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