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A sound decision regarding combination of datasets is critical for research validity. Data were collected between 1996 and 2000 via a 99-item survey of substance use behaviors. Two groups of 7th-12th grade students in predominately White communities are compared: 166,578 students from 193 communities with high survey participation and 41,259 students from 65 communities with lower participation. Hierarchical logistic models are used to explore whether the two datasets may be combined for further study of community-level substance use effects. "Scenario analysis" is introduced. Results suggest the datasets may reasonably be combined. Limitations and further research are discussed.

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This paper examines the effect of a student's own school adjustment as well as the contextual level of school adjustment (the normative level of school adjustment among students in a school) on students' self-reported use of alcohol. Using a dataset of 43,465 male and female 8th grade students from 349 schools across the contiguous United States who participated in a national study of substance use in rural communities between 1996 and 2000, multilevel latent covariate models were utilized to disentangle the individual-level and contextual effects of three school adjustment variables (i.e., school bonding, behavior at school, and friend's school bonding) on alcohol use. All three school adjustment factors were significant predictors of alcohol use both within and between schools. Furthermore, this study demonstrated a strong contextual effect: Students who attended schools where the overall level of school adjustment was higher reported lower levels of alcohol use even after taking their own school adjustment into account. The results demonstrate the importance of both a student's own level of school adjustment and the normative level of school adjustment among students in the school on an adolescent's use of alcohol. Differences in school adjustment across schools were quite strongly related to an adolescent's own alcohol use, indicating that school adjustment is an important aspect of school climate. Initiatives aimed at improving school climate may have beneficial effects on students' alcohol use.

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The Community Readiness Model (CR) offers a solution to the development of prevention strategies at the community level that makes use of community collaborations and community capacity. CR was administered in the U.S. Virgin Islands on St. Thomas, St. Croix, and St. John. All three islands scored lowest on dimensions of community climate and highest on knowledge of efforts to fight HIV/AIDS. The findings suggest that initial intervention efforts should improve the community climate of HIV/AIDS denial and stigma prior to introducing interventions that address HIV/AIDS risk behaviors. Community collaborators identify the interplay of social, structural, and political-economic factors for effective prevention.

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Prior to 2004, ephedra had been readily available to adolescents. Due to reports that use of ephedra produced a number of serious adverse consequences, including death, sales of the compound became illegal in the United States on April 12, 2004. Data are presented from a random sample of 156,050 students in grades 7 through 12 from 185 rural communities across the United States who completed the Community Drug and Alcohol Survey. This study provides a valuable epidemiological benchmark of reported rates of lifetime prevalence of ephedra by adolescents living in rural America before the sale of the drug became illegal (data were collected between 1996 and 2001). While there were small regional, racial, and gender differences, rates of adolescent use were, in general, very low. The highest rates of ephedra use were found among youth using other drugs, particularly stimulants. The study's limitations and implications are discussed.

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Inhalant use is of increasing concern as rates appear to be rising among young adolescents and gender differences narrowing. Data from 20,684 Mexican American and White non-Hispanic seventh- and eighth-grade males and females from the Western United States and 15,659 African American and White non-Hispanic seventh- and eighth-grade males and females from states in the southeastern United States collected via in-school surveys from 1996 to 2000 were analyzed using a variety of statistical techniques including multilevel modeling. Questions addressed in the study included: Does inhalant use vary by level of rurality? What effect does the ethnic composition of the community have on inhalant use and does this effect differ by an individual's ethnicity? Do males use more inhalants than females and does the level of use by males and females differ by individual ethnicity, ethnicity of the community, or level of rurality? Do males and females of different ethnicities initiate inhalant use at different ages? Limitations of the study and implications of findings for prevention are discussed and areas of future research are suggested. This study was funded by the National Institute on Drug Abuse.

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HIV and AIDS as a community(1) issue have not been dealt with extensively in the literature. One model that offers promise for development of effective prevention and intervention efforts is the Community Readiness Model, a nine-stage model that assesses the level of readiness of a community to develop and implement prevention programming. Data are presented from a Community Readiness assessment of 30 rural U.S. communities: 10 African American, 10 Mexican American, and 10 White non-Mexican American. Four to five key respondent interviews were conducted via telephone in each community using the Community Readiness Assessment protocol during 1999-2000. Limitations of the study and implications for prevention are discussed. This study was funded by the National Institute on Drug Abuse.

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This report examines (1) the prevalence of dating violence victimization from a national sample of rural adolescents and (2) patterns by gender and region. Analyses are based on 20,274 adolescents who reported violence victimization using the Community Drug and Alcohol Survey. The relationship of dating violence with gender and region was assessed with HLM5 using Bernoulli's logistic regression. Approximately 16% of adolescents reported being a victim of dating violence. Females reported higher incidence of victimization than males. Dating violence is more prevalent in the South. While it is important to address the underlying values in society that may contribute to dating violence, it is equally productive to include regional and cultural values.

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This study tests the impact of an in-school mediated communication campaign based on social marketing principles, in combination with a participatory, community-based media effort, on marijuana, alcohol and tobacco uptake among middle-school students. Eight media treatment and eight control communities throughout the US were randomly assigned to condition. Within both media treatment and media control communities, one school received a research-based prevention curriculum and one school did not, resulting in a crossed, split-plot design. Four waves of longitudinal data were collected over 2 years in each school and were analyzed using generalized linear mixed models to account for clustering effects. Youth in intervention communities (N = 4,216) showed fewer users at final post-test for marijuana [odds ratio (OR) = 0.50, P = 0.019], alcohol (OR = 0.40, P = 0.009) and cigarettes (OR = 0.49, P = 0.039), one-tailed. Growth trajectory results were significant for marijuana (P = 0.040), marginal for alcohol (P = 0.051) and non-significant for cigarettes (P = 0.114). Results suggest that an appropriately designed in-school and community-based media effort can reduce youth substance uptake. Effectiveness does not depend on the presence of an in-school prevention curriculum.

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This study examines the role of key informant community readiness assessments in a randomized group trial testing the impact of a participatory community-media intervention (which was also complemented by in-school efforts). These assessments were used to help match communities in random assignment, as a source of formative data about the community, as the basis for a coalition-building workshop, and as an evaluation tool, with a follow-up set of surveys approximately 2 years after the baseline survey. Results of the nested, random effects analysis indicated that the intervention influenced community knowledge of efforts and (at marginally significant levels) improved prevention leadership quality and community climate supportive of prevention efforts. There was evidence that the professional affiliation of informants in some cases had an effect on their assessments, which could be controlled in the analysis. The authors conclude that key informant community readiness assessments can usefully serve to supplement aggregated measures of individual attitudes and behavior (reported elsewhere for this study) in evaluating community-based interventions.

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Community readiness is a research-based theory that provides a basic understanding of the intervention process in communities. This theory allows us to accurately describe the developmental level of a community relative to a specific issue or problem. In order to move the community toward implementing and maintaining efforts that are effective and sustainable, community mobilization must be based on involvement of multiple systems and utilization of within-community resources and strengths. Successful local prevention and intervention efforts must be conceived from models that are community-specific, culturally relevant, and consistent with the level of readiness of the community to implement an intervention. The community readiness model is an innovative method for assessing the level of readiness of a community to develop and implement prevention programming. It can be used as both a research tool to assess distribution of levels of readiness across a group of communities or as a tool to guide prevention efforts at the individual level. This tool has proven useful in addressing a gamut of problems ranging from health and nutritional issues to environmental and social issues. The model identifies specific characteristics related to different levels of problem awareness and readiness for change.

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Results are reported from a national U.S. study of cigarette smoking carried out from 1996 to 2000 involving 68,270 adolescents. Hierarchical linear modeling was used to model smoking as a function of grade, gender, region, and community size (rurality). Significant effects were found for rurality, region, grade, and gender. The highest levels of smoking were found for rural adolescents, and adolescents living in the South. Males smoked more than females in all regions except the West, where the reverse was true. Given that rural adolescents smoke more "heavily" than do their nonrural peers, researchers must devote more attention to understanding the factors that underlie smoking initiation in rural youth.

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