Adolescents living in rural areas of the United States are more likely to abuse prescription drugs than are those living in urban areas, according to a report published online in the Archives of Pediatrics and Adolescent Medicine.
Even after study data were adjusted to account for differences between rural and urban adolescents in sociodemographics, health factors, and the abuse of other drugs, researchers found that residency in a rural area was independently associated with a significantly higher prevalence of prescription drug abuse. This pattern was not seen for abuse of any other substances, such as marijuana, cocaine, hallucinogens, inhalants, or alcohol, said Jennifer R. Havens, Ph.D., of the center on drug and alcohol research at the University of Kentucky, Lexington, and her associates.
Nationally, the rate of nonmedical use of prescription drugs ballooned by 212% between 1992 and 2003 among adolescents, to a rate nearly three times higher than that among people older than 18 years.
Many studies have assessed substance abuse among urban adolescents, but few have examined abuse among their rural counterparts. Moreover, the conclusions of the urban studies may not be generalizable to rural areas "owing to a unique set of contextual influences" that affect rural life, the investigators noted.
In particular, "the decimation of rural economies, precipitated by declines in the agricultural, manufacturing, and mining industries, and evidenced by high rates of unemployment," has contributed to profound economic and social decline in rural areas. Physical isolation, lack of insurance coverage, unavailability of local detoxification and psychiatric services, mistrust of the medical establishment, and the perceived stigma associated with seeking health care (especially mental health care) are all obstacles that disproportionately affect rural patients, they said.
To assess drug use among rural youths, Dr. Havens and her colleagues used data from the federal government’s National Survey on Drug Use and Health, an annual survey of a nationally representative sample of adolescents and adults that measures the prevalence and correlates of substance abuse. For this analysis, they included self-reported responses from 17,842 boys and girls aged 12-17 years.
Compared with respondents from urban and suburban areas, those from rural areas had significantly less income, were significantly more likely to have dropped out of school, and were significantly less likely to report excellent overall health. The prevalence of major depressive episodes was the same across the three geographic areas.
Adolescents residing in rural areas were 26% more likely than those in urban areas to report recent nonmedical use of prescription drugs, particularly pain relievers and tranquilizers. In all, 13% of rural adolescents reported any lifetime abuse of prescription drugs, compared with only 10% of urban adolescents, the researchers said (Arch. Pediatr. Adolesc. Med. 2010 Nov. 1 [doi:10.1001/archpediatrics.2010.217]).
Among the rural adolescents, nonmedical use of prescription drugs strongly correlated with dropping out of school and with having only one parent. Rural adolescents were 32% less likely to use illicit prescription drugs if they lived in a two-parent household than if they lived with only one parent.
It would seem, then, that interventions aimed at improving school retention and involving family members in adolescents’ lives might help prevent or reduce nonmedical prescription drug use in this population, Dr. Havens and her associates said.
Rural youths with a history of one or more major depressive episodes were more likely to abuse prescription drugs than were other youths, suggesting that they have poorer access to medical and/or psychiatric care than do adolescents residing in urban or suburban areas. This points to another potential source of intervention, "namely school-based counseling for mental health and substance abuse," the researchers added.
A particularly interesting finding was that the odds that a rural adolescent would abuse prescription drugs increased as that individual’s self-assessed health status declined. Other studies have shown that the prevalence of chronic pain is higher in rural areas, and that rural patients are less likely to have their health care needs met and more likely to forgo needed health care. This suggests that rural adolescents may have higher rates of self-medicating for pain, and that improving their health care could reduce the rate of self-medication, Dr. Havens and her colleagues said.
Future research should examine factors associated with use of pain relievers and tranquilizers among rural adolescents as "a next logical step," they added.
No financial conflicts of interest were reported.