title: Perceived ease of access to alcohol, tobacco and other substances in rural and urban US students.
abstract: BACKGROUND
  Ease of access to substances has been shown to have a direct and significant relationship with substance use for school-aged children. Previous research involving rural samples of middle and high school students reveals that perceived ease of access to substances is a significant predictor of recent use among rural adolescents; however, it is unclear if perceived access to substances varies between rural and urban areas. The purpose of the present study was to examine rural-urban differences in perceived ease of access to alcohol, smoking and chewing tobacco, marijuana, and seven other substances in the US state of Georgia in order to better inform and promote future substance use prevention and programming efforts in rural areas.
  
  
  METHODS
  Data were analyzed from the 2013 Georgia Student Health Survey II, administered in all public and interested private/charter schools in the state of Georgia. A total of 513 909 students (18.2% rural) indicated their perceived ease of access to 11 substances on a four-point Likert-type scale. Rural-urban differences were investigated using χ2 analysis.
  
  
  RESULTS
  In general, it appeared the rural-urban differences fell along legal/illicit lines. For middle school students, a significant difference in perceived ease of access was found for each substance, with rural students reporting greater access to smoking tobacco, chewing tobacco, and steroids, and urban students reporting greater access to alcohol, marijuana, cocaine, inhalants, ecstasy, methamphetamine, hallucinogens, and prescription drugs. Rural high school students reported higher access to alcohol, smoking tobacco, chewing tobacco, and steroids, with urban students reporting higher access to marijuana, cocaine, inhalants, ecstasy, and hallucinogens. Perceptions of ease of access more than doubled for each substance in both geographies between middle and high school.
  
  
  CONCLUSIONS
  The present study found multiple and fairly consistent differences between rural and urban students' perceived ease of access to a variety of substances, with rural students reporting higher levels of access to legal substances and urban students reporting higher levels of access predominantly to illicit substances. Most troubling were the high levels of perceived access to substances, particularly among high school students. Even within rural students who reported lower ease of access, more than half of students reported having at least somewhat easy access to marijuana. More than 60% of both rural and urban high school students reported easy access to alcohol. Future research should investigate ways to decrease the perceptions of access to substances in order to prevent use and abuse.
authors.affiliation: Mercer University School of Medicine, Macon, Georgia, USA. warren_jc@mercer.edu.
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Warren
authors.affiliation: Georgia Southern University, Statesboro, Georgia, USA. bsmalley@georgiasouthern.edu.
authors.forename: K Bryant
authors.initials: KB
authors.lastname: Smalley
authors.affiliation: Georgia Southern University, Statesboro, Georgia, USA. kbarefoot@georgiasouthern.edu.
authors.forename: K Nikki
authors.initials: KN
authors.lastname: Barefoot
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000517:prevention & control; D000438:Alcohols / Q000009:adverse effects; D002648:Child; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D010465:Perception; D012309:Risk-Taking; D012424:Rural Population / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology*; D000074606:Smoking Prevention; D013334:Students / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*; D014026:Nicotiana
chemical_list: D000438:Alcohols
keywords: Alcohol and Drug; Epidemiology; Health Promotion; North America; Public Health; Researcher; Youth