Underage Rural Drinking : Survey Data and Implications for Educators

This article reports data collected in a rural Texas county that explores the beliefs and perceptions of youth about alcohol use. Results from the study suggest high rates of underage drinking and present significant health risks. The data also shed some light on how youth perceive parents, responsibilities, access, and prevention strategies with regard to alcohol usage. Implications for rural educators and health care providers are discussed in light of the findings, with an emphasis on both prevention and intervention.

Large-scale epidemiological studies/surveys of current alcoholism rates in the US have involved various approaches to studying abuse and dependence across different subsets of the US population, including youth.
Variations in these approaches to understanding alcoholism have included focusing on differences in ethnic groups (Grant et al., 2004), personality and cognitive differences (Finn, Mazas, Justus, & Steinmetz, 2002;Giancola & Moss, 1998), and even neurochemical perspectives (Moselhy, Georgiou, & Kahn, 2001). In an effort to contribute to this knowledge base, this study focuses on better understanding the relation between underage drinking and rural youth, and reports data collected in a rural Texas county that explores the beliefs and perceptions of youth about alcohol use.
Underage drinking appears to occur frequently in the US. According to the findings from the 2002-2006 National Survey on Drug Use and Health (Pemberton, Colliver, Robbins, & Gfroerer, 2008), approximately 10.8 million persons aged 12 to 20 (28.3 percent of this age group) reported drinking alcohol in the past month. Approximately 19 percent (7.2 million) were binge drinkers (five or more drinks on one occasion), and 6.2 percent (2.4 million) reported heavy drinking, defined as binge drinking on at least five days in the past 30 days.
Although the alcohol use of rural youth has been less well studied than urban and suburban youth, a growing body of literature has documented various significant findings. For example, 19.8 percent of underage persons in rural counties reported current binge drinking, compared with 17.7 and 20.8 percent of those who lived in counties in large metropolitan areas (population of 1 million or more) and small metropolitan areas (population of less than 1 million), respectively (Pemberton, et al., 2008). Furthermore, in a study of rural youth in West Virginia conducted by Guo et al.  (Bernards et al., 2009), and social norms (Ward & Gryczynski, 2009), with peer substance use and parental knowledge as mediating factors for drinking behaviors (Wang et al., 2009). Given that underage drinking persists despite efforts to intervene, perhaps gathering specific data directly from youth regarding their opinions toward alcohol and the reasons they consume alcohol may help identify ways to decrease alcohol consumption by minors. With that in mind, the purpose of this study was to gather information from rural youth with regard to their behaviors, frequency of use and perceptions related to alcohol consumption. It is hoped this information will further contribute to the general body of knowledge of rural youth alcohol use, ultimately resulting in more efficacious interventions for lessening the occurrence of rural underage drinking and, thereby, decreasing the frequency of the health-related problems associated with such behaviors.

Method
This quantitative study used survey research to investigate underage alcohol use among high school seniors aged 18 and 19 years in a single rural county in central Texas. The county has a population of approximately 36,000 and covers approximately 550 square miles. The population density is roughly 60 people per square mile.
Twenty-eight percent of the population is under age 18, and 8.5% of the population is between the ages of 18-24. Over 19% of the residents under age 18 live in poverty. Approximately 726 of the 36,000 residents are aged 18 or 19 years, meaning that this group constitutes approximately 2% of the overall population (United States Census Bureau, 2008). The largest towns in the county have populations of 13,523 and 5,418. Over 265,000 acres in the county are used for farmland. The ethnic/racial composition of the county is mixed, with approximately 8.5% Black or African American, 40.4% Hispanic, and 49.5% White non-Hispanic (numbers total greater than 100% because some individuals report more than one category). The three school districts of the county serve approximately 6,500 students.

Participants
The principal investigators recruited subjects from the two largest high schools in the rural county described above. The sample was limited to students aged eighteen and older because they could legally consent to participate independently in this study and had more years of school experience than younger students. Once the surveys were completed, the investigators used SPSS to analyze the data. Some surveys were incomplete and could not be used. The total number of useable surveys was 38 (Female N=20, Male N=18). The small sample size was expected, given the sparse population in the rural county that was studied, as well as the lack of student access to technology, often characteristic of rural living. Furthermore, the researchers limited the overall potential sample size by electing to collect data only from 18 and 19 year old subjects in high school. Although the sample size is small, it represents over five percent of the Table 1 Self-reported Experiences and Consequences of Alcohol Usage total population of 18 and 19 year old persons in the county. This representation is further strengthened by the data on ethnicity, showing that 42% identified themselves as Hispanic and 44% identified as White. With these facts in mind, the data yielded some intriguing findings that are of interest to mental health and medical practitioners serving rural, adolescent populations.

Findings
The following self-report data are summarized in the tables below, and include respondents experience with alcohol, consequences of alcohol usage, reasons for alcohol use, perceptions of why their peers use alcohol,

Experience with Alcohol
The vast majority of the participants reported previous alcohol consumption (80% of female and 94% of male respondents  Table   1).

Consequences of Alcohol Use
Respondents were asked a series       The data also included respondents perceptions and experiences of their parents use and acceptance of alcohol in the home (see Table 6). For example, over one third (34%) reported that their parents allow them to use alcohol at home, with a third of those saying that they are allowed to drink alcohol in their home whenever they want. It is interesting to note that 75% of participants know parents who let other people's kids drink in their home, although these data provide no indication of how many parents this actually constitutes. Forty percent of participants also reported that their parents do not know how much they drink, meaning, of course, that 60% of the participants reported that their parents knew exactly how much they drink. This is supported by the data showing that the same number of respondents (60%) reported that their parents have seen them drink, while 57% stated that they discuss alcohol use with their parents.  that participants reported that they started drinking between 14 15 years of age suggests that educational programs that address the risks associated with alcohol consumption should begin well before the high school years. Further supporting the need for early intervention, the present study suggests that those who start drinking at an earlier age may drink more heavily than their peers who start later. Furthermore, educational and intervention programs designed to lessen underage drinking should consider that while most youths believe that it is a problem among their peers, they do not consider themselves as part of the problem.
More than half of the participants in the present study

Conclusion
Ultimately, the problem of underage alcohol use in rural communities will not be solved with short-term, isolated interventions. Rather, schools and communities must develop comprehensive plans that utilize family school partnerships to addressing the culture of alcohol consumption. Moreover, efforts must be made to provide desirable alternatives for adolescents.
These findings support for the need to develop more specific curricula focused exclusively on early adolescents, especially those in middle/junior high school. Furthermore, the present study helps shed light on rural adolescents perceptions regarding underage drinking and the degree to which they consider alcohol use and abuse problematic. These data have important implications for the prevention and treatment of alcohol abuse in rural, underage populations and suggest directions for future research. As the findings of this study are limited to a small sample of youth in one specific rural area, further research in this topic is critical for a better understanding of underage rural drinking. Qualitative data may be a helpful addition to existing studies in order to gain a phenomenological perspective of the problem.
Additionally, a national rural sample would shed light on regional trends and differences. Future research should also look at reasons why young people abstain from drinking. Finally, there is a need to link assessment and prevention/intervention data so that we can better understand which interventions are most effective in lowering youth alcohol usage in rural populations.