Ethnic differences in adolescent perceptions of and attitudes toward substance use.

The current study identified ethnic differences in beliefs about substance use and assessed their impact on frequency of use of various substances. Participants were 1,398 Caucasian and African-American rural secondary school students. Only tobacco or cigarettes had significant differences for both cognitive and frequency of use variables. Results revealed that Caucasian students reported higher past 12-month tobacco use compared to African-American students. Congruently, African-American students reported perceiving significantly greater wrongness in tobacco use. In contrast, Caucasian students had a significantly greater perception of harm of tobacco use compared to African-American students. When these cognitive variables were entered as mediators of the ethnicity-cigarette use relationship, only the attitude of wrongness variable served as a significant partial mediator. These data highlight the importance of addressing attitudes as part of substance use prevention.

Posttraumatic stress disorder in rural primary care: improving care for mental health following bioterrorism.

CONTEXT: Recent bioterrorism attacks have highlighted the critical need for health care organizations to prepare for future threats. Yet, relatively little attention has been paid to the mental health needs of rural communities in the wake of such events. A critical aspect of bioterrorism is emphasis on generating fear and uncertainty, thereby contributing to increased needs for mental health care, particularly for posttraumatic stress disorder, which has been estimated to occur in 28% of terrorism survivors. PURPOSE: Prior experience with natural disasters suggests that first responders typically focus on immediate medical trauma or injury, leaving rural communities to struggle with the burden of unmet mental health needs both in the immediate aftermath and over the longer term. The purpose of the present article is to draw attention to the greater need to educate rural primary care providers who will be the frontline providers of mental health services following bioterrorism, given the limited availability of tertiary mental health care in rural communities. METHODS: We reviewed the literature related to bioterrorism events and mental health with an emphasis on rural communities. FINDINGS AND CONCLUSIONS: Public health agencies should work with rural primary care providers and mental health professionals to develop educational interventions focused on posttraumatic stress disorder and other mental disorders, as well as algorithms for assessment, referral, and treatment of post-event psychological disorders and somatic complaints to ensure the availability, continuity, and delivery of quality mental health care for rural residents following bioterrorism and other public health emergencies.

Implementation of an aggressive random drug-testing policy in a rural school district: Student attitudes regarding program fairness and effectiveness.

School districts are increasingly initiating random drug-testing (RDT) programs in an effort to curb substance-use rates among students, yet little is known about student attitudes toward RDT and potential obstacles to program acceptance and effectiveness. The authors surveyed 1011 9th through 11th grade students in 2 rural high schools in North Florida regarding the pending implementation of one of the most aggressive RDT programs in the nation. A significant majority of students predicted that RDT would be effective, yet students were more clearly divided in their perceptions of the fairness and the accuracy of testing. Student perceptions of whether there is a drug problem at their school proved to be a robust predictor of perceptions of policy fairness. Student substance-use rates were more limited predictors of policy effectiveness and fairness. These results may prove useful to school administrators, health professionals, and policy makers seeking to build acceptance for RDT in their schools.

PTSD and substance use: unrecognized sequelae of bioterrorism in primary care providers.

BACKGROUND: Psychological casualties following public health emergencies are likely to significantly outnumber physical casualties. However, postevent psychological disorders may be underrecognized by primary care providers (PCPs). METHODS: Rural PCPs in northern and central Florida were interviewed using a series of open-ended questions to assess knowledge of likely mental disorders, their risk factors, and preferred treatment options following such events (n=21). RESULTS: PTSD was identified by 14% and substance abuse by 10% of the sample. Physicians were significantly more likely to identify posttraumatic stress disorder (PTSD) as an expected postevent psychological disorder than nonphysician providers. PCPs were significantly more likely to endorse counseling (86%) than medications (43%) as a preferred treatment option. CONCLUSIONS: Our findings support the need for increased education and training regarding the mental health consequences of bioterrorism in rural PCPs, particularly for nursing-level and other nonphysician providers. Improvements in knowledge may enhance preparedness for such emergencies.