Bullying and physical violence and their association with handgun carrying among youth growing up in rural areas.

OBJECTIVES: This study builds on prior research showing a strong relationship between handgun carrying and delinquent behaviors among urban youth by examining the association between handgun carrying trajectories and various types of violence in a rural sample. METHODS: This study uses data from a longitudinal cohort study of 2002 public school students in the United States from 12 rural communities across 7 states from ages 12-26 (2005-2019). We used logistic regressions to assess associations of various bullying and physical violence behaviors with latent trajectories of handgun carrying from adolescence through young adulthood. RESULTS: Compared to youth with very low probabilities of carrying a handgun in adolescence and young adulthood, trajectories with high probabilities of handgun carrying during adolescence or young adulthood were associated with greater odds of using bullying (odds ratios (ORs) ranging from 1.9 to 11.2) and higher odds of using physical violence during adolescence (ORs ranging from 1.5 to 15.9) and young adulthood (ORs ranging from 1.9 to 4.7). These trajectories with higher probabilities of handgun carrying were also associated with greater odds of experiencing physical violence like parental physical abuse and intimate partner violence, but not bullying. CONCLUSION AND IMPLICATION: Experiencing and using bullying and physical violence were associated with specific patterns of handgun carrying among youth growing up in rural areas. Handgun carrying could be an important focus of violence prevention programs among those youth.

"The Real Cost" Smokeless campaign: changes in beliefs about smokeless tobacco among rural boys, a longitudinal randomized controlled field trial.

BACKGROUND: The prevalence of current smokeless tobacco (SLT) use in 2019 among high school students was 4.8%, and the overall rate of SLT use was higher among high school boys (7.5%) than girls (1.8%). The U.S. Food and Drug Administration (FDA) launched "The Real Cost" Smokeless media campaign in April 2016 to educate rural youth about the dangers of SLT use. In this study, we evaluate the effectiveness of "The Real Cost" Smokeless campaign. METHODS: We use a 3-year (Jan 2016 - Dec 2018) randomized controlled longitudinal field trial that consists of a baseline survey of boys and a parent/guardian and four follow-up surveys of the boys. The cohort includes 2200 boys who were 11 to 16 years old at baseline and lived in the rural segments of 30 media markets (15 treatment markets and 15 control). "The Real Cost" Smokeless campaign targets boys who are 12 to 17 years old in 35 media markets. It focuses primarily on graphic depictions of cosmetic and long-term health consequences of SLT use. The key outcome measures include beliefs and attitudes toward SLT that are targeted (explicitly or implicitly) by campaign messages. RESULTS: Using multivariate difference-in-difference analysis (conducted in 2019 and 2020), we found that agreement with 4 of the 11 explicit campaign-targeted belief and attitude measures increased significantly from baseline to post-campaign launch among boys 14 to 16 years old in treatment vs. control markets. Agreement did not increase for boys 11-13 years old in treatment vs. control markets and only increased for one targeted message for the overall sample. CONCLUSIONS: These findings suggest that "The Real Cost" Smokeless campaign influenced beliefs and attitudes among older boys in campaign markets and that a campaign focused on health consequences of tobacco use can be targeted to rural boys, influence beliefs about SLT use, and potentially prevent SLT use.

Rural young males' acceptance & receptiveness to technology-based interventions for dating violence prevention: A qualitative descriptive study.

INTRODUCTION: Rural youth are twice as likely as urban youth to experience some forms of teen dating violence (TDV), and significant barriers to accessing support services for physical, psychological, sexual violence. However, rural youth remain understudied and undersampled. Rural young men, in particular, are at risk for experiencing or perpetrating dating violence influenced by regional and sociocultural risk factors that promote male supremacy ideals while also impeding male help-seeking. Technology-based interventions circumvent some of these risk factors by offering confidential and reliable support. This study investigates rural young males' acceptability of technology-based interventions for fostering healthy relationships and preventing dating abuse, including their preferences for intervention content and features. METHODS: Three online focus groups (n = 14) and phone interviews (n = 13) were conducted with rural young males. Participants were stratified by age (15-17 and 18-24 year-olds). Most were White (81%) from the United States Midwest (65%). Semi-structured interview data were analyzed using Qualitative Description (QD), guided by the Unified Theory of Acceptance and Use of Technology (UTAUT). RESULTS: Three themes identified were (1) Scarcity of Useful Resources, (2) Socio-Structural Challenges for Intervention Uptake, with two subthemes (2a) Rural-Specific Structural Barriers and (2b) Rural Masculinity Disrupting Help-seeking; (3) Finally, participants discussed Functionality and Design Needs, itemizing their intervention "must-have" in terms of content, resources, and features. CONCLUSION: This qualitative study identified obstacles and facilitators to using technology-based interventions for dating violence prevention among young rural males and offers pragmatic "ready-to-use" recommendations for the development of technology-based anti-dating violence interventions for rural youth.

Building youth leadership skills and community awareness: Engagement of rural youth with a community-based leadership program.

AIMS: Community leadership programs have the potential to positively impact many aspects of young people's development, as well as the community. This study, therefore, aims to understand the experiences of the young people, particularly rural youth, involved with the Western Bulldogs Youth Leadership Project (WBYLP), a 7-month program for Year-9 and Year-10 students, and if the developmental assets are a good framework to inform future program development. METHOD: A transformative mixed-methods design was used and included surveys with 96 participants at two time points, and semistructured interviews with eight participants. RESULTS: Quantitatively leadership significantly increased, particularly due to increases in the domains of understanding self and decision-making skills. Social competencies increased, though total developmental assets did not. Interviews identified four primary themes: Perspective taking, self-efficacy, community awareness, and decreased isolation. CONCLUSIONS: These results indicate that participants developed both individual skills relating to leadership and social skills. The participants also developed their awareness of the issues in their community.

Use of the Veggie Meter® as a tool to objectively approximate fruit and vegetable intake among youth for evaluation of preschool and school-based interventions.

BACKGROUND: Reflection spectroscopy is an emerging, non-invasive objective measure used to approximate fruit and vegetable intake. The present study aimed to use a reflection spectroscopy device (the Veggie Meter®, Longevity Link Corporation, Salt Lake City, UT, USA) to assess skin carotenoid status in preschool, middle- and high-school students and to examine associations between skin carotenoids and self-reported dietary intake. METHODS: In Autumn 2018, we used the Veggie Meter® to assess skin carotenoids and age-appropriate validated dietary assessment measures to approximate fruit and vegetable (FV) intake. Preschool participants completed a previously validated pictorial liking tool using an iPad (Apple Inc., Cupertino, CA, USA). Middle-school participants completed selected questions from the validated School Physical Activity and Nutrition (SPAN) (Michael & Susan Dell Center for Healthy Living, University of Texas, Austin, TX, USA) questionnaire regarding frequency of their FV and beverage intake on the previous day, with additional questions about physical activity. High-school participants' FV intake was assessed using the Fruit and Vegetable Screener (National Cancer Institute, Bethesda, MD, USA). Spearman correlation coefficients were used to determine bivariate associations between measures of dietary intake and Veggie Meter®-assessed skin carotenoid levels. RESULTS: Mean (SD) Veggie Meter® readings were 266 (82.9), 219 (68.1) and 216 (67.2) among preschool, middle- and high-school students. There was an inverse association between soda intake and Veggie Meter® readings (r = -0.22, P = 0.03) among middle-school students; and a positive association between daily fruit intake and Veggie Meter® readings (r = 0.25, P = 0.06) among high-school students. CONCLUSIONS: The Veggie Meter® comprises a promising evaluation tool for preschool and school-based nutrition interventions.

Trajectories of Dating Violence Victimization and Perpetration among Rural Adolescents.

Research is inconclusive about the trajectory of dating violence during adolescence and whether there are differences across gender and race/ethnicity. We examined dating victimization and perpetration trajectories among a diverse sample of rural youth (N = 580, 52.7% female, 49% Black, 39% White, 11% Hispanic or other minorities) in middle and high school who were surveyed annually across four years and explored the influences of gender and ethnicity. The results based on cohort-sequential latent growth modeling revealed that for boys, victimization peaked at 11th grade, and then declined. For girls, victimization was stable throughout adolescence. Perpetration was reported less frequently and increased steadily for males and females. For White youth, victimization peaked at grades 9 and 10, followed by a decline. For Black youth, victimization followed a linear increase. Perpetration trajectory followed a linear increase for White and Black but not Hispanic youth. The findings indicate that the developmental progression of dating violence during adolescence varies by demographics. The discussion focuses on future directions for research on teen dating violence among rural youth and implications for prevention and interventions initiatives.

Maternal support and deviance among rural adolescents: The mediating role of self-esteem.

INTRODUCTION: Supportive mothering buffers against adolescent deviance, but the precise mechanisms underlying this relationship are poorly understood. The current investigation tested the extent to which self-esteem mediated the maternal support-deviance link and whether it varied by adolescent age and sex. METHODS: Data were collected from 911 middle and high school students in the rural South (53.6% female, Mage = 14.70 years). Main model tests were completed in SEM. RESULTS: Results indicated that maternal support and self-esteem were positively associated and negatively to deviance, and that self-esteem mediated the support-deviance link. These associations did not differ by adolescent age. However, moderating effects by sex were significant, where maternal support had a greater effect on girls' self-esteem, while self-esteem had a greater effect on boys' deviance. CONCLUSIONS: Findings provide some evidence of how maternal support is associated with a positive self-concept that in turn decreases the likelihood of engaging in deviant behaviors.

The promise and the reality: a mental health workforce perspective on technology-enhanced youth mental health service delivery.

BACKGROUND: Digital technologies show promise for reversing poor engagement of youth (16-24 years) with mental health services. In particular, mobile and internet based applications with communication capabilities can augment face-to-face mental health service provision. The literature in this field, however, fails to adequately capture the perspectives of the youth mental health workforce regarding utility and acceptability of technology for this purpose. METHODS: This paper describes results of in-depth qualitative data drawn from various stakeholders involved in provision of youth mental health services in one Australian rural region. Data were obtained using focus groups and semi-structured interviews with regional youth mental health clinicians, youth workers and support/management staff (n = 4 focus groups; n = 8 interviews) and analysed via inductive thematic analysis. RESULTS: Results question the acceptability of technology to engage clients within youth mental health services. Six main themes were identified: young people in a digital age, personal connection, power and vulnerability, professional identity, individual factors and organisational legitimacy. CONCLUSIONS: These findings deepen the understanding of risks and challenges faced when adopting new technologies in mental healthcare. Recommendations for technology design and implementation in mental health services are made.

Perceived Peer Delinquency and Externalizing Behavior Among Rural Youth: The Role of Descriptive Norms and Internalizing Symptoms.

Little research has examined the way in which perceptions of peer behavior (i.e., descriptive norms) influence externalizing behavior among rural adolescents. Using a social norms framework, the current study examined gender differences in the relationship between perceived delinquency among friends and externalizing behavior in a sample of rural adolescents. Based on previous research, the authors proposed that adolescents experience negative emotional responses when they believe that their peers are engaging in delinquency, which subsequently influences externalizing behavior. Consequently, internalizing symptoms were explored as a mediator of the relationship between perceived friend delinquency and externalizing behavior. Data came from the NC-ACE Rural Adaptation Project, a longitudinal panel study of adolescents in two rural, economically disadvantaged counties with exceptional racial/ethnic diversity (29 % White, 25 % African American, 25 % American Indian, 12 % Mixed Race/Other, 9 % Hispanic/Latino). Using multiple group structural equation modeling (N = 3489; 51 % female), results indicated that perceived friend delinquency was significantly related to externalizing behavior and this relationship did not vary by gender. Internalizing symptoms fully mediated the relationship between perceived friend delinquency and externalizing behavior and the path between perceived friend delinquency and internalizing symptoms was stronger for males. Implications of these relationships for prevention and intervention programming for externalizing behavior were highlighted.

Increasing access to sexual health care for rural and regional young people: Similarities and differences in the views of young people and service providers.

OBJECTIVE: This study aims to describe the views of sexual health service providers on access issues for young people and consider them together with the views of young people themselves. DESIGN: A cross-sectional mixed-methods study design involving semi-structured interviews with health service providers and an electronic survey with young people. SETTING: Four towns in rural and regional Queensland, Australia. PARTICIPANTS: A total of 32 service providers: 9 sexual health nurses, 8 general practitioners, 6 school-based youth health nurses, 5 sexual health educators, 2 Australian Aboriginal health workers and 2 youth workers. There were 391 young people who participated in the Young People's Survey. MAIN OUTCOME MEASURES: Themes generated from interviews with service providers and quantitative data from young people addressing access to sexual and reproductive health (SRH) services for rural and regional young people. RESULTS: Service providers frequently identified structural barriers, confidentiality and lack of awareness of SRH services as barriers for young people seeking SRH care. Young people also reported that structural factors such as transport, cost and service operating hours were important; however, they placed greater value on personal attributes of service providers, particularly welcoming and non-judgemental attitudes. CONCLUSION: Health service policy and training focused on attitudinal qualities of individual service providers may improve access to SRH services for young people. Selective staff recruitment and professional development are important to increase sensitivity to youth issues. Promotion of non-judgemental and confidential care may also improve access for youth.

Review of interventions to increase hearing protective device use in youth who live or work on farms.

AIMS AND OBJECTIVES: To identify and compare hearing protection interventions for youth working and living on farms. BACKGROUND: Noise-induced hearing loss represents a significant risk factor for injury, disability and death in agricultural populations due to an inability to receive sensory information that can indicate dangerous situations. Despite the availability of hearing protection devices, rates of utilisation remain low, while rates of noise-induced hearing loss are high within the agricultural youth population. DESIGN: Comprehensive review of the literature. METHOD: Electronic database searches were conducted to identify research studies of hearing protection interventions for youth living or working on farms. RESULTS: Three intervention studies were identified as meeting the review criteria, with additional reanalysis studies based on the original intervention studies. The intervention studies demonstrated increased use of hearing protection devices among youth who received the interventions compared to the control groups although audiometry testing results were not improved as a result of the intervention. CONCLUSIONS: The findings of this review highlight the need for additional research into the effectiveness of hearing protection device use as a noise-induced hearing loss preventative measure in youth who live or work on farms and the creation of effective interventions to increase hearing protection device use and decrease Noise-induced hearing loss risk. RELEVANCE TO CLINICAL PRACTICE: It is recommended that nurses be educated in the areas of health promotion relevant to farming communities to be able to effectively meet their rural clients' needs in relation to noise-induced hearing loss. Working with youth, families, and schools, as well as developing community partnerships, can facilitate the dissemination of hearing protection promotion.

The association of alcohol use and heavy drinking with subsequent handgun carrying among youth from rural areas.

PURPOSE: Alcohol use and handgun carrying are more prevalent among youth in rural than urban areas and their association may be stronger among rural adolescents. Alcohol use may be modifiable with implications for reducing handgun carrying and firearm-related harm. We examined the association between lagged alcohol use and subsequent handgun carrying in rural areas and examined variation in the association by developmental stages, hypothesizing that it would be stronger among adolescents than youth adults. METHODS: We used a longitudinal sample of 2,002 adolescents from ages 12 to 26 growing up in 12 rural communities in 7 states with surveys collected from 2004 to 2019. We estimated the association of lagged past-month alcohol use on handgun carrying in the subsequent 12 months using population-average generalized estimating equations with logistic regression on multiply imputed data. FINDINGS: During adolescence (ages 12-18), those who drank heavily had 1.43 times the odds (95% CI = [1.01, 2.03]) of subsequent handgun carrying compared to those who did not drink alcohol, and those who consumed alcohol but did not drink heavily had 1.30 times the odds of subsequent handgun carrying compared to those who did not drink (95% CI = [0.98, 1.71]). During young adulthood (ages 19-26), associations of alcohol use (OR = 1.28; 95% CI = [0.94, 1.63]) and heavy drinking (OR = 1.38; 95% CI = [1.08, 1.68]) were similar to adolescence. CONCLUSIONS: Alcohol use and subsequent handgun carrying were positively associated during adolescence and young adulthood among individuals who grew up in rural areas, similar to findings in urban areas. Reducing alcohol use may be an important strategy to prevent handgun carrying and firearm-related harm among young people in rural areas.

Needs ranking: A qualitative study using a participatory approach.

Youth disengagement is a growing concern globally, yet little research has been done to explore participatory approaches that can engage youth as co-creators of community programs that improve their resilience. The primary objective of the study is to report on the results of an innovative participatory approach used in the Eastern and Western Cape provinces, South Africa, to engage vulnerable youth in needs ranking. Data for this paper were collected in three phases. Using information gleaned from the literature review (Phase I), authors compiled a list of core needs on separate cards. In Phase II, youth discussed and ranked each need in terms of importance for their community. In Phase III, youth participated in focus group discussions on the ranked needs as part of a broader discussion on youth risk behaviours. Thematic analysis was used for qualitative data. Needs ranking data were analysed using descriptive statistics. Although expressed priority needs differed amongst communities, combined data revealed the top expressed priorities as further education (priority 1; 85%), skills development (priority 2; 74%) and career development and training (priority 3; 68%). Differences between critical needs as discussed in the literature and those perceived by youth were noted. Focus group data validated the expressed priority needs and highlighted that vulnerable youth felt valued through the needs ranking activity. Involving youth in the assessment of their needs can improve the value of information obtained, which in turn can facilitate better allocation of community resources.

Investigating the Adoption of Precautionary Behaviors Among Young Rural Adults in South Iran During COVID-19.

COVID-19 is an unprecedented challenge for public health worldwide. Reducing the incidence of the disease requires protective measures to prevent virus transmission. Understanding those factors influencing preventive behavior is the first step in preventing the spread of the disease. This study investigates factors affecting youth intention and preventive behaviors in the face of COVID-19 through the health belief model by using a cross-sectional survey collected through an online questionnaire. The sample comprises 304 rural youth in South Iran who were selected through a random sampling technique. The results reveal that perceived severity, perceived benefits, public health beliefs, perceived self-efficacy, and the cue to act positively and significantly affect preventive behaviors. The model explains 59% of variance changes in rural youth preventive behaviors during COVID-19. Cue to action is the strongest and self-efficacy was the weakest determinant of youth's preventive behavior. This study confirms that the HBM framework has appropriate predictive power and is an effective tool for investigating preventive behaviors during COVID-19. These results provide important policy implications for the development of policies that aim to avoid the further spread of COVID-19 between young citizens.

Support over Social Media among Socially Isolated Sexual and Gender Minority Youth in Rural U.S. during the COVID-19 Pandemic: Opportunities for Intervention Research.

Sexual and gender minority (SGM) rural adolescents are at risk for higher levels of social isolation, a well-known risk factor for depression and other negative health outcomes. We qualitatively examined how rural SGM youth seek emotional and informational support, which are protective factors for social isolation on social media (SM) regarding their SGM identity, and determined which SM platforms and tools are most effective in providing support. We conducted semistructured online interviews with rural SGM teens who screened positive for social isolation in spring 2020 and used a thematic analysis approach to analyze the data. Sixteen youths participated in interviews. Themes included seeking emotional support through SM groups and communities, seeking emotional support in designated online SGM spaces, using SM feeds for informational support, and disclosing SGM identity differentially across platforms. SM-based interventions could be leveraged to provide emotional and informational support for rural SGM youth across specific SM platforms and consider whether they are providing emotional or information support. Interventions focused on informational support may best be used on content-based platforms. Those designed to combat social isolation and connect marginalized SGM youths to similar others might benefit from community and forum-based platforms.

Tobacco use among Appalachian adolescents: An urgent need for virtual scale out of effective interventions.

Tobacco use, typically initiated during adolescence, can escalate into young adulthood, even among experimenting or intermittent users. Despite declines in cigarette smoking among US adolescents, use of other tobacco products and poly-tobacco are on the rise among Appalachian adolescents. Unfortunately, Appalachian adolescent tobacco users also are less likely to receive effective tobacco interventions due to various barriers: a) accessibility (e.g. service and provider shortages, affordability, and transportation; b) acceptability (e.g. issues of privacy and stigma); and c) cultural relevance. The present review provides critical considerations synthesized from an extensive body of literature on the suitability of virtual tobacco interventions, the need for well-timed interventions that address complex tobacco use, and the rationale for leveraging and scaling evidence-based interventions inform novel interventions for Appalachian adolescent tobacco users. Borrowing strength from existing in-person evidence-based adolescent tobacco interventions and state-of-the-art virtual health services, a well-planned virtual scale out of tobacco interventions holds potential to minimize barriers unique to Appalachia.

Intake of Fruits, Vegetables, and Sugar-Sweetened Beverages among a Sample of Children in Rural Northern Ontario, Canada.

There is evidence to suggest that dietary intake of children differs by rural/urban place of residence: rural children may have a higher intake of foods high in fat and sugar than those living in urban environments. The aim of this study was to examine the intake of fruits and vegetables (FV) and the frequency of sugar-sweetened beverage (SSB) consumption, among a sample of rural children in Northern Ontario, Canada, in two different seasons. Sociodemographic factors and children's FV and SSB intake were measured using two repeated cross-sectional surveys, and seasonal information was based on the month of data collection. Logistic regressions were used to examine the odds of children eating five or more FVs, and the odds of 'frequently or always' consuming SSBs. During the fall, children reported eating five or more FV more often, when compared to winter (53.9% vs. 48.3%). In the fall, 25.8% of children reported 'frequently or always' drinking SSB, compared with 16.9% in winter. Indigenous children were less likely to eat five or more FV (OR 0.34 (95% CI 0.12-0.95)) in the fall when compared to non-Indigenous children. Findings indicate that intake of FV among rural students in this region is low, and the frequency of SSB is high, when compared with national recommendations.

Maternal Stress Moderates the Relationship of Food Insufficiency with Body Mass Index Trajectories from Childhood to Early Adulthood among U.S. Rural Youth.

Background: Findings on the relationships between household food insufficiency (HFI), maternal stress, and youth body mass index (BMI) are mixed, possibly due to cross-sectional study designs and measurement issues. Furthermore, little is known about how childhood exposure to HFI and maternal stress influences BMI into young adulthood among rural youth. We aimed to determine the independent and moderating relationships of HFI and maternal perceived stress on youth BMI trajectories from age 9 to 24 years. Methods: We used longitudinal data from rural New York youth (n = 341). At youth age 9 years, parents reported HFI using a reliable one-item measure, and mothers responded to the 10-item Perceived Stress Scale (PSS; range: 0-40). BMI was calculated (kg/m2) from objective measures of height and weight at 9, 13, 17, and 24 years. Multivariate random-intercept trajectory models estimated the relationships of HFI and PSS on BMI trajectories (p < 0.05 for main effects, p < 0.10 for interactions). Results: At age 9 years, 16.4% experienced HFI and mean (standard deviation) BMI and PSS were 18.4 (3.6) kg/m2 and 7.7 (2.9), respectively. HFI and PSS were not associated with BMI trajectories (p = 0.18, p = 0.64, respectively), but their interaction was significant (p < 0.01). Each one-unit increase in PSS was associated with 0.6 (0.2) kg/m2 higher mean change in BMI trajectories for youth in food-insufficient, compared with food-sufficient, households. Conclusions: Higher levels of maternal stress in food-insufficient households may lead to greater increases in BMI from childhood to young adulthood. Public health interventions should simultaneously address parental stress and quality food access among low-income rural households.

Rural Communities and Violence.

Among US geographic regions classified as rural, death rates are significantly higher for children and teens as compared with their urban peers; the disparity is even greater for Alaskan Native/American Indian and non-Hispanic black youth. Violence-related injuries and death contribute significantly to this finding. This article describes the epidemiology of violence-related injuries, with a limited discussion on child abuse and neglect and an in-depth analysis of self-inflicted injuries including unintentional firearm injuries and adolescent suicide. Potential interventions are also addressed, including strategies for injury prevention, such as firearm safe storage practices.

Nature as an Ecological Asset for Positive Youth Development: Empirical Evidence From Rural Communities.

Despite increasing emphasis on youth contact with nature and associated benefits, research has not examined the direct relationship between adolescents' nature-based experiences and holistic measures of positive youth development (PYD). This gap may stem from the lack of interdisciplinary work on nature and PYD. Our study integrates multiple disciplinary perspectives to explore direct associations between time in nature, connection to nature, and the five Cs of PYD (competence, connection, confidence, character, and caring) as well as the "sixth" C of contribution. From 2015 to 2016, we collected data from 587 diverse South Carolina middle school students (57% female, 40% BIPOC) between the ages of 11 and 14 (M age = 12.9) and living in predominantly low-income communities. OLS regression analyses indicated that across all youth, self-reported connection to nature was a consistent positive correlate of overall PYD and each of the individual Cs. Time in nature was associated with overall PYD and competence. Findings demonstrate significant associations between nature-based experiences and PYD and underscore the importance of ensuring that diverse youth can access and enjoy the developmental benefits of nature and nature-based recreation opportunities.