Session: Substance Use Among Adolescents in Low Income Rural Communities (Society for Social Work and Research 21st Annual Conference - Ensure Healthy Development for all Youth)

Symposium Theme and Importance: It is well documented that adolescent substance use is associated with a host of negative outcomes such as dating violence, poor health, risky behaviors, and negative relationships. Rural youth are often at an increased risk of substance use compared to urban and suburban youth due to unique risk factors present in rural areas, including geographic isolation, high unemployment, and community disadvantage that can exacerbate their substance use. However, despite these increased risk factors, little is known about adolescent substance use in rural racially/ethnically diverse settings.

The current symposium aims to fill these research gaps. The Rural Adaptation Project is a 5-year panel study of about 7,000 youth from low-income rural, and ethnically/racially diverse counties in the Southeast that have shown significantly elevated rates of youth violence. Starting in year 4, data were collected assessing middle- and high-school students lifetime frequency of alcohol, cigarette, marijuana, prescription drug, and inhalant use. Data were collected using the School Success Profile Plus, an online youth self-report that assesses perceptions about school, family, friends, neighborhood, self, health and wellbeing.

Description of Studies: The first paper examines alcohol, cigarette, and marijuana use separately using binary logistic regression, relating the likelihood of use to social capital, anti-social capital, and social capital deprivation factors. Although consonant with prior research, these analyses were not informative for inhalant and prescription drug use because of their low frequencies in this population. Further, they did not address the cumulative risk that multiple substances and their relative frequencies that prior findings suggest are important.

Although a cumulative risk measure may be informative, such an approach implies that the impact of each individual substance is equivalent. Alternatively, the ways in which these substances combine, and the frequency of their use, are important factors in assessing cumulative risk. To fully unravel the complexities of substance use in this unique population, the other papers utilize Latent Class Analysis to identify groups of youth with distinct patterns of substance use at different levels of schooling, and to test the predictive validity of these classes on known risks associated with substance use.

The second paper shows that middle and high school students differ, with three largely linear classes of middle school youth (Abstainers, Low-Intensity Users, and Intensive Users), and four non-linear classes of high school youth (Abstainers, Initiators, Users and Severe Users). The third paper demonstrates that these classes have high predictive validity on a series of known risk factors for substance use. The fourth paper indicates, however, that the middle and high school classes are not isomorphic to their respective grade levels and that youth experience a gradual increase in type and frequency of substance use over time.

Taken together, these studies provide evidence of age-specific typologies and risk patterns for substance use in disadvantaged, rural youth. Predictive modeling can be used identify youth for targeted intervention planning. Results suggest that substance use prevention programs should target polysubstance users in order to protect them from these risk factors.