Recent Alcohol, Tobacco, and Substance Use Variations between Rural and Urban Middle and High School Students.

The use of addictive substances by adolescents is a major public health concern; however, rural vs. urban variations are poorly understood. The purpose of the current study was to examine rural-urban differences in the prevalence of recent use of 11 substances in grades 6-12 in a statewide sample of students from the Georgia Student Health Survey II (n = 513,909). We found that rural-urban differences in substance use depend largely upon grade level, with rural middle school students demonstrating higher rates of alcohol, smoking tobacco, and chewing tobacco use, and urban high school students demonstrating higher rates of illicit drugs.

Women's health care: the experiences and behaviors of rural and urban lesbians in the USA.

INTRODUCTION: Previous research has consistently demonstrated that, in comparison to their cisgender heterosexual counterparts, lesbians face a multitude of women's healthcare-related disparities. However, very little research has been conducted that takes an intersectionality approach to examining the potential influences of rural-urban location on the health-related needs and experiences of lesbians. The purpose of this study was to quantitatively compare rural and urban lesbians' access to women's health care, experiences with women's healthcare providers (WHCPs), and preventive behavior using a large, diverse sample of lesbians from across the USA. METHODS: A total of 895 (31.1% rural and 68.9% urban) lesbian-identified cisgender women (ie not transgender) from the USA participated in the current online study. As part of a larger parent study, participants were recruited from across the USA through email communication to lesbian, gay, bisexual, and transgender (LGBT)-focused organizations and online advertisements. Participants were asked to complete a series of questions related to their women's healthcare-related experiences and behaviors (ie access to care, experiences with WHCPs, and preventive behavior). A series of χ2 analyses were utilized in order to examine rural-urban differences across dependent variables. RESULTS: An examination of sexual risks revealed that relatively more rural lesbians reported at least one previous male sexual partner in comparison to the urban sample of lesbians (78.1% vs 69.1%, χ2(1, N=890)=7.56, p=0.006). A similarly low percentage of rural (42.4%) and urban (42.9%) lesbians reported that they have a WHCP that they see on a regular basis for preventive care. In terms of experiences with WHCP providers, relatively fewer rural lesbians indicated that their current WHCP had discussed/recommended the human papillomavirus (HPV) vaccination in comparison to urban lesbians (27.5% vs. 37.2%; χ2 (1, N=796)=7.24, p=0.007). No other rural-urban differences in experiences with WHCPs emerged - few rural and urban lesbians had been asked about their sexual orientation by their WHCP (38.8% and 45.0%, respectively), been provided with appropriate safe-sex education by their WHCP (21.4% and 25.3%), had their last HIV/sexually transmitted infection screening instigated by their WHCP (if applicable; 15.7% and 19.5%), and reported that their WHCP seems knowledgeable about lesbian health concerns (56.5% vs 54.6%). In terms of preventive behavior, significantly fewer rural lesbians aged 40 years or more had received a mammogram in the past 3 years (63.2% vs 83.2%; χ2(1, N=163)=8.36, p=0.004) when compared to their urban counterparts. No other significant rural-urban differences in preventive behaviors emerged. A similarly low percentage of rural and urban lesbians indicated that they have received the HPV vaccination (22.8% and 29.0%, respectively) and/or have had a HIV/STI screening (43.0% and 47.8%), Pap test (62.0% and 64.5%) or breast exam (59.2% and 62.8%), in the past 3 years. CONCLUSIONS: The current findings highlight that rural lesbians in the USA, in comparison to urban lesbians, may experience elevated health risks related to being more likely to have at least one previous male sexual partner, less likely to be recommended the HPV vaccination by a WHCP, and, for those 40 or older, less likely to receive routine mammogram screenings. Furthermore, rural lesbians appear to engage in similarly low rates of HPV vaccination and regular HIV/STI screenings, Pap tests, and clinical breast exams as their urban counterparts. Given the increased cervical and breast cancer risks associated with rural living, the current findings underscore the dire need for health promotion efforts aimed at increasing rural lesbians' engagement in routine pelvic and breast exams.

Perceived ease of access to alcohol, tobacco and other substances in rural and urban US students.

INTRODUCTION: Ease of access to substances has been shown to have a direct and significant relationship with substance use for school-aged children. Previous research involving rural samples of middle and high school students reveals that perceived ease of access to substances is a significant predictor of recent use among rural adolescents; however, it is unclear if perceived access to substances varies between rural and urban areas. The purpose of the present study was to examine rural-urban differences in perceived ease of access to alcohol, smoking and chewing tobacco, marijuana, and seven other substances in the US state of Georgia in order to better inform and promote future substance use prevention and programming efforts in rural areas. METHODS: Data were analyzed from the 2013 Georgia Student Health Survey II, administered in all public and interested private/charter schools in the state of Georgia. A total of 513 909 students (18.2% rural) indicated their perceived ease of access to 11 substances on a four-point Likert-type scale. Rural-urban differences were investigated using χ2 analysis. RESULTS: In general, it appeared the rural-urban differences fell along legal/illicit lines. For middle school students, a significant difference in perceived ease of access was found for each substance, with rural students reporting greater access to smoking tobacco, chewing tobacco, and steroids, and urban students reporting greater access to alcohol, marijuana, cocaine, inhalants, ecstasy, methamphetamine, hallucinogens, and prescription drugs. Rural high school students reported higher access to alcohol, smoking tobacco, chewing tobacco, and steroids, with urban students reporting higher access to marijuana, cocaine, inhalants, ecstasy, and hallucinogens. Perceptions of ease of access more than doubled for each substance in both geographies between middle and high school. CONCLUSIONS: The present study found multiple and fairly consistent differences between rural and urban students' perceived ease of access to a variety of substances, with rural students reporting higher levels of access to legal substances and urban students reporting higher levels of access predominantly to illicit substances. Most troubling were the high levels of perceived access to substances, particularly among high school students. Even within rural students who reported lower ease of access, more than half of students reported having at least somewhat easy access to marijuana. More than 60% of both rural and urban high school students reported easy access to alcohol. Future research should investigate ways to decrease the perceptions of access to substances in order to prevent use and abuse.

Measurement of nontraditional sexuality in women.

The Women's Nontraditional Sexuality Questionnaire (WNSQ) was developed, and its factor structure, reliability, and convergent and concurrent validity assessed, in two samples of midwestern U.S. college women. Study 1 (N=243) used exploratory factor analysis to assess the instrument dimensionality. In Study 2 (N=627), the fit of the four-factor solution derived from Study 1 was assessed using confirmatory factor analysis. Results supported a four-factor solution comprising: Involvement in Casual Sex, Self-Pleasuring, Degree of Sexual Interest, and Using Sex as a Means to an End. WNSQ total score and subscales had acceptable internal consistency reliability. Convergent validity was supported by significant correlations of the WNSQ and its subscales with a measure of casual sex (the Sociosexual Orientation Index), and with a measure of adherence to traditional feminine sexual norms (the Purity subscale of the Femininity Ideology Scale). The WNSQ showed weak relationships with a measure of risky sexual health communication practices (Health Protective Sexual Communication Scale). The WNSQ offers promise for study of women's sexual attitudes and behaviors.

Savoring Interventions Increase Positive Emotions After a Social-Evaluative Hassle.

Achieving a high quality of life is dependent upon how individuals face adversity. Positive psychological interventions are well-suited to support coping efforts; however, experimental research is limited. The purpose of the current research was to examine whether different savoring interventions could increase important coping resources (i.e., positive emotions) in response to a social-evaluative hassle. We completed an experimental mixed subject design study with a university student sample. All participants completed a hassle induction task and were then randomly assigned into different intervention groups. Positive emotion ratings were collected at three points in time (baseline, post-induction task, post-intervention). Results revealed a significant time x intervention interaction effect, such that individuals in the savoring the moment intervention reported higher levels of positive emotions (at post-intervention) compared to individuals assigned to the true control group, guided imagery control group, and savoring through reminiscence intervention. Such findings represent a significant extension to savoring theory and offer support for savoring the moment exercises as a primary prevention strategy to bolster effective responses to social-evaluative hassles.

Rural mental health and psychological treatment: a review for practitioners.

Practitioners in rural areas face particular challenges in providing psychological services, ranging from disparate rates of mental disorders to unique circumstances in treating special populations. In this article, we discuss the burden of mental disorders in rural areas, current trends in integration of mental health care and primary care, and unique concerns practitioners face in treating two special populations in rural areas (children and families, and older adults and their caregivers). Implications for practice are also discussed.

Disparities Elimination Summer Research Experience (DESRE): An Intensive Summer Research Training Program to Promote Diversity in the Biomedical Research Workforce.

The Disparities Elimination Summer Research Experience (DESRE) was created to provide hands-on health equity research training opportunities to undergraduate and graduate students, particularly those from backgrounds underrepresented in biomedical research. Funded by NIH's National Institute on Minority Health and Health Disparities, a total of 22 students participated in 4 annual cycles of an intensive, 6-week, full-time, residential research training program consisting of didactics, community immersion experiences, peer mentoring, ethics training, and hands-on health disparities research. Demand for the program was high; by the 4th year of implementation, more than 500 applications were received for the cohort's six slots. More than half of DESRE participants came from minority-serving institutions and/or identified as a member of a minority group. Students reported a significant increase in self-reported competency across all of the program's 26 learning objectives from pre- to post-assessment. Further, the program had a 77% success rate in promoting a career in biomedical research and/or health disparities elimination, including 100% of minority participants either entering a graduate program and/or entering careers focused on health equity. Key success factors and lessons learned are discussed.

The Impact of Rurality on Likelihood of Drunk Driving and Riding With a Driver Under the Influence Among High School Students.

PURPOSE: The purpose of this study was to examine the importance of rural location in the likelihood of adolescent drunk driving and riding in a vehicle with a driver under the influence while controlling for a variety of student-, school-, and county-level factors. METHODS: Data from the 2013 Georgia Student Health Survey (GSHS) II (a statewide assessment of student health in public school students in Georgia) were analyzed using multilevel binary regressions to examine rural-urban differences in prevalence of driving under the influence (11th and 12th graders only; n = 114,907) and riding with a driver under the influence (9th -12th graders; n = 258,610), controlling for school-level race, gender, and income, in addition to county-level education level, unemployment, alcohol use, and smoking. FINDINGS: Across geographies, students were twice as likely to report riding with a driver under the influence (10.32%) as driving under the influence (4.16%). While both outcomes were more likely among rural adolescents in unadjusted analyses, in adjusted analyses, rural adolescents were not significantly more likely to drive under the influence (ORadj = 1.19; P = .055), but they were significantly more likely to ride with a driver under the influence (ORadj = 1.18; P = .002). CONCLUSIONS: Our findings suggest that riding with a driver under the influence rather than driving under the influence may be a more pressing public health issue for adolescents in rural areas. Future research focused on the formative work necessary to build novel, culturally tailored interventions should be conducted to minimize the associated substantial burden of motor vehicle deaths within rural adolescents.

Discrepancy between Actual and Perceived Weight Status in Rural Patients: Variations by Race and Gender.

The study's goal was to determine if differences in weight misperception by race and/or gender occur within a sample of economically disadvantaged rural patients with diabetes and/or hypertension. Diabetic and hypertensive patients were enrolled in the study from a network of federally qualified health centers (FQHCs) in the rural South. Multivari-ate logistic regression analysis suggests that, even when controlling for age, education level, employment status, and poverty, rural African American patients with chronic disease are more likely than their White counterparts to misperceive their weight status (OR = 1.709, p = .037). This difference in perceived weight occurred despite the absence of an underlying difference in actual weight status between African American and White patients (p = .171). In addition, rural men were much more likely than rural women to misperceive their weight status (OR = 2.688, p < .001). Implications for intervention development and implementation are discussed.

Discrepancy in Motivation for Weight Loss and Exercise in Rural Patients.

OBJECTIVES: We explored the extent to which discrepancy between motivation for weight loss and exercise is related to obesity among rural patients with chronic disease, and identified the psychosocial correlates of this discrepancy. METHODS: 497 patients with diabetes and/or hypertension were recruited from a network of Federally Qualified Health Centers in the rural South and completed a battery of assessments. RESULTS: Most persons in the sample (83.1%) were overweight and 65.0% were obese. For motivation for change, 70.8% reported being in the Action stage or higher for weight loss, whereas only 24.9% reported being in the Action stage or higher for motivation for exercise. When controlling for age, education level, income, sex, and race/ethnicity, individuals who were motivated for weight loss but not exercise were twice as likely to be obese (p = .005). Race and sex were significantly associated with this discrepancy, with African-American patients 1.7 times as likely (p = .05) and women 2.3 times as likely to be discrepant (p = .001). CONCLUSIONS: Findings underscore the importance of focusing not simply on weight loss among rural patients with chronic disease, but rather to incorporate specific activities designed to build simultaneous motivation for engaging in exercise.

Connection between Depression and Inability to Fill Prescriptions in Rural FQHC Patients with Chronic Disease.

The purpose of this paper was to (1) examine the rates of elevated depression symptoms among a sample of rural Federally Qualified Health Center (FQHC) patients with chronic disease and (2) determine if an inability to afford general prescription medications within the past 12 months is a significant predictor of depression symptoms among these patients. These data came from Project EDUCATE, an ongoing five-year study designed to be a large-scale, multifocal examination of the needs and experiences of rural FQHC patients with hypertension and/or diabetes. A total of 497 rural FQHC patients completed surveys (including a series of psychosocial questions, the Multigroup Ethnic Identity Measure and the Center for Epidemiologic Studies Depression scale) as part of phase one of the project; 438 of these with complete data are included in the current analytic sample. Results revealed that 53.0% of the sample screened positive for depression, and over half of those who screened positive reported not being able to afford their prescription medications at least once within the past 12 months (51.3% vs. 26.3% non-depressed). Further, even after controlling for age, ethnic identity attachment, sex, education level, employment status, income, insurance status, recent inability to afford needed medical care, hypertensive status, mental health diagnosis, and family history of mental illness, patients who could not afford to fill their prescriptions in the past 12 months were 2.6 times as likely to screen positive for depression (ORADJ = 2.476, p = 0.002) as those who could afford their medications. Overall, results of this study suggest that, among rural patients diagnosed with chronic disease, depressive symptomatology may be alarmingly high and an inability to afford medications may be an important risk factor for depression symptoms. These results highlight the need for increased attention to prescription medication affordability among rural patients with chronic disease in order to reduce the risk of comorbid depression.

Differences in Psychosocial Predictors of Obesity Among LGBT Subgroups.

PURPOSE: The purpose of the current study was to examine the overall presence of and differences in rates of overweight/obesity among a large, nationally diverse sample of lesbian, gay, bisexual, transgender (LGBT)-identified individuals (i.e., cisgender lesbians, cisgender gay men, cisgender bisexual women, cisgender bisexual men, transgender women, and transgender men) and to identify specific psychosocial predictors of obesity within each of the six LGBT subgroups. METHODS: A total of 2702 LGBT-identified participants participated in the online study. Participants completed a series of demographic questions (including weight and height) and the Depression Anxiety Stress Scale 21. RESULTS: The percentage of participants who were overweight/obese did not differ significantly across LGBT subgroups, with 61.1% of the total sample being overweight/obese. However, the percentage of participants who self-reported body mass indexes in the obese range differed significantly across the six LGBT subgroups, with the highest prevalence in transgender men (46.0%). In addition, the predictors of obesity varied by subgroup, with age a significant predictor for cisgender lesbians, cisgender gay men, and cisgender bisexual women, relationship status for cisgender bisexual women, employment status for both cisgender gay men and cisgender bisexual women, education level for cisgender lesbians, and depression, anxiety, and stress for cisgender gay men. None of the examined psychosocial factors emerged as predictors of obesity for cisgender bisexual men, transgender women, or transgender men. CONCLUSION: These findings suggest that there are substantial variations in the presence and predictors of obesity across LGBT subgroups that support the need for culturally tailored healthy weight promotion efforts within the LGBT community.

Differences in health risk behaviors across understudied LGBT subgroups.

OBJECTIVE: The purpose of the current study was to conduct a large-scale, geographically diverse comparison of health risk behaviors between a broad range of sexual orientation and gender identity groups to more fully understand the health risks of subgroups within the LGBT community. METHOD: A total of 3,279 individuals self-identifying as LGBT (e.g., lesbian, gay, bisexual, pansexual, transgender, genderqueer, and/or another gender or sexual minority) were recruited from across the United States through 2 sequentially implemented online recruitment methods. Participants completed a demographic assessment and the Health Risk Questionnaire (assessing diet and exercise, substance use and smoking, motor vehicle risks, sexual behaviors, violence, and medical risk-taking). RESULTS: Significant differences were found across genders for 18 of the 28 health risk behaviors investigated and across sexual orientations for 23 behaviors. Major differences emerged particularly with relation to diet and exercise behaviors, as well as sexual risk-taking, substance use, and medical risk-taking. Groups with notably elevated health risk behaviors included transgender women (diet and exercise behaviors), cisgender men (alcohol-related risk-taking), bisexual participants (substance use), and both transgender men and pansexual participants (self-harm). Differences between transgender participants and genderqueer or nonbinary participants were stark, indicating that these frequently combined groups have distinct health risk profiles. CONCLUSIONS: Results suggest that there are extensive and largely variable levels of engagement in health risk behaviors within the LGBT community. In addition, gender and sexual orientation subcategories that are traditionally collapsed into 1 category (i.e., transgender and bisexual) evidenced strikingly different risks when examined independently. Recommendations for future research and LGBT health promotion efforts are discussed.

Rural-Urban Differences in Perceptions of Child Overweight Among Children and Adolescents, Their Guardians and Health Care Professionals in the United States.

RESEARCH OBJECTIVE: Children and adolescents residing in rural environments with higher prevalence of an overweight population may develop inaccurate perceptions of a healthy weight. This study examines rural-urban differences in perceptions of child overweight among overweight (85 ≤ BMI percentile < 95) and obese children (BMI percentile ≥ 95), their guardians and health care providers (HCPs), and children's concomitant weight control. METHODS: The cross-sectional study was based on the 2005-2010 NHANES data (1,844 overweight and obese children and adolescents, aged 8-15 years). Rurality was defined using the 2003 RUCC. The weight status was based on the standardized measures of children's height and weight. Children reported whether they considered themselves overweight and whether they were trying to lose weight. Proxy respondents (ie, guardians) reported whether they considered their child to be overweight and whether an HCP had ever told them their child was overweight. Weighted percentages and predicted probabilities from multivariable logistic regressions were calculated, accounting for the complex, multistage, probability sampling design and nonresponse. FINDINGS: Rural residents comprised 18.8% of the study population; 41.8% of them were overweight and 58.2% were obese compared to 46.7% and 53.3% of urban peers, respectively. Misperceptions of children's weight status were 11.3 and 6.0 percentage points higher in rural children and their guardians, respectively. Recall of an HCP identification of child overweight was 6.3 percentage points lower among rural versus urban guardians. CONCLUSION: Obesity prevention efforts may be fostered by improving accuracy of child overweight perceptions. This may be particularly impactful in rural settings, where weight misperceptions are high.

Ethnic Identity Attachment and Motivation for Weight Loss and Exercise Among Rural, Overweight, African-American Women.

Rural and minority women are disproportionately impacted by the obesity epidemic; however, little research has studied the intersection of these disparity groups. The purpose of this study was to examine the influence of racial identity on motivation for weight loss and exercise among rural, African-American women with an obesity-linked chronic disease. A total of 154 African-American women were recruited from the patient population of a Federally Qualified Health Center in the rural South to complete a questionnaire battery including the Multigroup Ethnic Identity Measure and separate assessments of motivation for weight loss and exercise. Multivariate analyses, controlling for age, education status, insurance status, and body mass index revealed that attachment to ethnic identity was predictive of motivation for exercise but not for weight loss. Our findings suggest that attachment to ethnic identity may be an important factor in motivation for change among African-American women, particularly with respect to exercise, with direct implications for the development of culturally and geographically tailored weight loss interventions.

An Examination of Past and Current Influences of Rurality on Lesbians' Overweight/Obesity Risks.

PURPOSE: The purpose of our study was to separately examine past (i.e., rural or non-rural background) and present (i.e., current rural or urban location) influences of rurality on the weight status and diet/exercise behaviors of lesbians. METHODS: A total of 895 lesbians participated in the online study. Participants were surveyed regarding their rurality status, weight/height, and diet/exercise patterns. A 2×2 (location×background) ANCOVA was conducted to explore influences of rurality on body mass index (BMI), while controlling for age, race, and education. Chi-square analyses were used to examine the relationship between dimensions of rurality and diet/exercise behaviors. RESULTS: There was a significant main effect of current location on BMI. No significant interaction between location and background on BMI was found nor was there a significant main effect of background. Lesbians currently living in rural areas were on average obese (M=30.61), with significantly higher BMIs than urban-residing lesbians (M=28.53). The only significant differences that emerged for lesbians' diet/exercise patterns were for current location-more rural-residing lesbians reported they never engage in exercise in comparison to their urban-residing counterparts, with a greater percentage of urban-residing lesbians reporting frequent exercise. Rural lesbians were also more likely to report a diet high in protein. CONCLUSION: Findings suggest that current rather than past influences of rurality may have a significant impact on lesbians' weight and diet/exercise behaviors and highlight significant obesity-related health disparities for rural-residing lesbians. These findings offer support for the development of culturally-appropriate healthy diet/exercise and weight promotion efforts that are accessible to rural lesbians.

Association between Depression and Aggression in Rural Women.

Rural women represent approximately 20% of women living in the United States, yet research on the specific mental health needs of rural women is limited. Given the well-recognized gender-linked difference in depression rates, its correlated depressive symptoms in women still need much investigation. While emerging notions of depression in men embrace potential symptoms related to irritability and aggression, less research has focused on the potential role of aggression in depressed women. This connection may be particularly relevant for rural women who face unique mental health stressors in comparison to their urban counterparts. The purpose of this study was to examine if aggression is linked to depression for rural women in order to identify potential unique symptomatology and presentation for rural women. As part of a larger initiative, a sample of 54 participants was recruited from the patient population at a Federally Qualified Health Center (FQHC) in rural southeast Georgia to participate in a quantitative survey. The survey explored demographics, depression, and aggressive behavior. Mean total score of aggression in depressed women was significantly higher than non-depressed women (p < 0.001), and within the entire sample depression scores were significantly related linearly to aggression, with aggression explaining 16% of the variance found in depression scores (ß = .399, r2 = .159, p = 0.003). This study suggests that aggressive behavior may be linked to depression for rural women, and underscores the need for future research investigating if depression presents differently for rural women.