Differences in Recent Alcohol, Tobacco, and Substance Use between Rural and Urban Students

objective: The purpose of the current study was to examine rural-urban differences in the prevalence of past 30-day use of each of 11 substances within each middle and high school grade level (i.e., 6^th-12^th).

methods: Data for the current study came from the 2013 Georgia Student Health Survey II. A total of 513,909 student responses were included in the current analysis (18.2% rural; 80.2% urban). As part of the survey, students indicated their past 30-day use of 11 substances: alcohol, smoking tobacco, chewing tobacco, marijuana, cocaine, inhalants, steroids, ecstasy, methamphetamines, hallucinogens, and prescription drugs.

results: Rural students in 6^th-11^th grades each were more likely to report using alcohol, smoking tobacco, and chewing tobacco in comparison to their urban peers, and rural 7th graders were also more likely to report prescription drug use. Differences in illicit drug use were found exclusively in the high school sample (with higher rates among urban students across drugs in 10^th-12^th grade), and these differences increased in magnitude across grades. However, by 12^th grade, urban students had the highest rates across the majority of substances; with the exception of chewing tobacco (which remained higher among rural students) and smoking tobacco (no differences).   

conclusions:  Rural-urban differences in substance use depend largely upon grade level, with rural middle school students demonstrating consistently higher rates of alcohol and tobacco use, and urban high school students demonstrating higher rates of illicit drug use. These results support the need for future investigations of the differing motivations for substance use between rural and urban students.