title: Examining the effects of school-based drug prevention programs on drug use in rural settings: methodology and initial findings.
abstract: BACKGROUND
  Although there have been substantial advances in knowledge about drug prevention over the last decade, the majority of school-based drug prevention studies have been conducted in urban settings. There is little knowledge about the effectiveness of such programs when they are implemented in rural populations.
  
  
  OBJECTIVE
  To examine the prevention effects of school-based drug prevention programs implemented in rural populations.
  
  
  METHODS
  Mixed model or 2-level meta-analysis of trials based on school-based drug prevention programs that included rural populations. A total of 182 trials were coded for urbanicity of schools and 22 separate trials were selected for the analysis conducted in this paper. A total of 435 distinct analyses were examined from these 22 trials.
  
  
  RESULTS
  We found a modest but consistent beneficial impact of drug prevention programs on later use as well as level of use. Regarding later drug use, the largest impact was on those who were not using at baseline and those exposed to an interactive program; the results were much larger for marijuana and other drugs compared to alcohol or tobacco, while inhalant use was less affected than other drug categories. Regarding level of use, the impact was greatest 6 months after the trial ended, with diminishing effects thereafter.
  
  
  CONCLUSIONS
  Evidence exists for a small but systematic beneficial effect of drug prevention programs in rural settings. It is likely that these programs have produced a mild reduction in new use of substances but have had little impact on those already using substances.
authors.affiliation: Department of Epidemiology and Biostatistics, University of South Florida College of Public Health, Tampa, FL 33620, USA. hbrown@hsc.usf.edu
authors.forename: C Hendricks
authors.initials: CH
authors.lastname: Brown
authors.forename: Jing
authors.initials: J
authors.lastname: Guo
authors.forename: L Terri
authors.initials: LT
authors.lastname: Singer
authors.forename: Katheryne
authors.initials: K
authors.lastname: Downes
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Brinales
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006293:Health Promotion / Q000592:standards; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D015397:Program Evaluation / Q000379:methods*; D012107:Research Design; D012424:Rural Population; D012574:Schools; D019966:Substance-Related Disorders / Q000517:prevention & control*; D014481:United States