OBJECTIVES: This study compared prevalence of substance use among high school seniors in rural and urban areas from 1976 through 1992. METHODS: We used data collected for these years from urban (n = 75,916) and rural (n = 51,182) high school seniors. Thirty-day prevalence for alcohol, cigarettes, marijuana, cocaine, LSD, and inhalant use, binge drinking, smoking a pack or more of cigarettes a day, and daily alcohol and marijuana use were evaluated. RESULTS: Substance use declined from 1976 through 1992. In 1976, urban students had greater prevalence for most substances, but by 1992, rural and urban students were similar, with rural students having higher prevalence for alcohol and cigarette use (particularly excessive use). Trends were similar for both sexes, though rural girls showed a later catch-up to use levels of urban girls. CONCLUSIONS: Rural students are currently at risk approximately equal to that of urban students. Other studies have demonstrated the association of substance use with increased morbidity and mortality. Policy alterations and health education programs should address this pattern in the nation's rural areas.
Rates of HIV antibody testing remain at approximately 45% of the general population. To more effectively design interventions to increase testing, comprehensive information is needed to understand the barriers to HIV testing. A measure of barriers to HIV testing was developed using the major barriers identified in the literature on barriers to health care utilization (Melnyk, 1988), and tested with a diverse group of individuals at high risk for HIV, including heterosexuals, men who have sex with men, injected drug users, and sex workers. An exploratory factor analysis indicated that the factor structure was replicated over 2 years of data collection. Three factors--Structural Barriers, Fatalism/Confidentiality Concerns, and Fear--emerged for both years. The reliabilities ranged from .75 to .87, indicating moderate to high internal consistency.
A non-equivalent control group design was used to examine effectiveness of a drug and alcohol abuse prenatal care health education program for pregnant teens (N = 212) in the Mississippi delta region of southern Illinois. Experimental group posttest knowledge scores were significantly higher than control group scores; however, no significant differences occurred in attitudes between the two groups at posttest. Frequency of drug use decreased substantially for both experimental and control groups at posttest; however, significantly more experimentals than controls indicated they reduced or quit using drugs. The experimental group had a significantly lower rate of diabetes, anemia, and sexually transmitted diseases, and possibly a lower rate of spontaneous abortion depending on the statistical test used. Data suggest prenatal care health education programs may be effective methods for increasing patient awareness about the dangers of drug and alcohol abuse and may have an effect on infant and maternal outcomes.
Intimate violence has been recognized as a major problem in the United States. The financial and social hardships of declining rural economies, the social isolation of distance and poor transportation, inadequate social services for families in crisis, and limited options for women who might otherwise leave abusive partners are risk factors for intimate violence in rural areas. Church-based prevention programs are considered particularly useful in rural communities. If preventive health programs engage them properly, rural church members' overlapping social structures and their especially interconnected social circles can spread and support new ideas and practices. This study was conducted in four rural, predominately white, southern Illinois counties. The survey instrument used consisted of four subscales, measuring knowledge about, attitudes toward, and practices to prevent intimate violence as well as religious ideology. Overall, clergy knowledge and attitudes about intimate violence in this study did not necessarily translate into actual prevention practices against intimate violence. However, liberal clergy tend to employ prevention practices more often when compared with conservative clergy. Nevertheless, rural churches and their clergy seem to be promising sources for diffusion of intimate violence prevention information, attitudes and acceptable standards of behavior to rural communities.
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