title: Substance abuse by youth and young adults in rural America.
abstract: OBJECTIVE
  Addressing substance abuse in rural America requires extending our understanding beyond urban-rural comparisons to how substance abuse varies across rural communities of different sizes. We address this gap by examining substance abuse prevalence across 4 geographic levels, focusing on youth (age 12-17 years) and young adults (age 18-25 years).
  
  
  METHODS
  The analysis is based on 3 years (2002-2004) of pooled data from the National Survey on Drug Use and Health. We measure rurality using a four-tier consolidation of the 2003 Rural-Urban Continuum Codes: urban, rural-adjacent, rural-large, and rural-small and medium.
  
  
  RESULTS
  Rural youth have higher alcohol use and methamphetamine use than urban youth and the more rural the area, the higher the use. Rural young adults living in rural-large areas have higher rates of substance abuse than their urban peers; those living in the most rural areas have nearly twice the rate of methamphetamine use as urban young adults. Rural youth are more likely than urban youth to have engaged in the high-risk behavior of driving under the influence of alcohol or other illicit drugs.
  
  
  CONCLUSIONS
  Higher prevalence rates, coupled with high-risk behavior, place rural youth and young adults at risk of continued substance use and problems associated with this use. Rural community infrastructure should be enhanced to support substance abuse prevention and intervention for these populations.
authors.affiliation: Maine Rural Health Research Center, Muskie School for Public Service, University of Southern Maine, Portland, Maine 04104-9300, USA. davidl@usm.maine.edu
authors.forename: David
authors.initials: D
authors.lastname: Lambert
authors.forename: John A
authors.initials: JA
authors.lastname: Gale
authors.forename: David
authors.initials: D
authors.lastname: Hartley
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003625:Data Collection; D006801:Humans; D015995:Prevalence; D012424:Rural Population; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology