Differences in economic, cultural, social and educational factors between urban and rural areas in Canada might influence behavioural and mental health outcomes. However, most research assessing differences in urban and rural patterns of substance use has been conducted in the United States. Within Canada, information is limited on whether students who attend urban and rural schools differ in substance use. To address this gap, this report analyzes data from regularly occurring student surveys and outlines differences and similarities between students who attend urban and rural schools. Though this report is technical in nature, it has implications for a broader audience such as those working in prevention programming and schools, and others who work with youth. Understanding differences in Canada between adolescent students in urban and rural communities can help guide best practices in prevention programs for schools and communities.
To develop a picture of student substance use across Canada, and to help understand differences in students who attend urban and rural schools, data from regularly occurring student surveys were contributed to the Canadian Centre on Substance Abuse (CCSA) by members of the Student Drug Use Surveys (SDUS) Working Group. The SDUS group represents jurisdictions with dedicated programs of reliable, valid, regularly occurring, provincial or national student surveys. The SDUS members contributed data from the following surveys:
- British Columbia Adolescent Health Survey (2013)
- Alberta data from the Youth Smoking Survey (2012–2013)
- Alcohol and Other Drugs: Students in Manitoba survey (2007)
- Quebec Survey of Smoking, Alcohol, Drugs and Gambling in High School Students (2013)
- Student Drug Use Survey in the Atlantic Provinces:
- Newfoundland and Labrador (2012)
- New Brunswick (2012)
- National data from the Youth Smoking Survey (YSS) (2012–2013)
- Health Behaviour in School-Aged Children (HBSC) survey (2009–2010)
Rurality was determined using school postal codes and defined using the statistical area classification system developed by Statistics Canada (2001). Estimates were provided by each survey for urban and rural settings to determine approximate prevalence rates for the following outcomes: alcohol use, drinking five or more drinks on a single occasion, driving after alcohol or cannabis use, cannabis use, daily or almost daily cannabis use, illicit drug use, and prescription drug abuse. Second, these same outcomes were assessed by each contributing survey using multivariate logistic regressions controlling for sex, grade level (or age), with grades assessed ranging from seven to 12 depending on the survey, and socioeconomic status to determine if they differed as a function of whether students attended school in an area defined as urban or rural.
Overall, the most consistent findings were related to alcohol use and associated risk behaviours. Seven out of eight of the contributing surveys indicated that students who attended schools in rural settings were more likely to report alcohol use. Students who attended rural schools were also more likely to report drinking five or more drinks on a single occasion with five out of the eight surveys observing a significant effect. Of the surveys that assessed drinking and driving, three out of four reported that students in a rural setting were more likely to report driving after consuming alcohol. Rural students were also found to be more likely to drive after using cannabis according to three of the four surveys that assessed this outcome. Findings with respect to cannabis use in general, however, were mixed, with three out of eight surveys indicating students who attended school in a rural setting were more likely to report cannabis use. Only two of eight surveys found that students who attended rural schools were at increased likelihood of daily or almost daily cannabis use. Finally, reports of differences in illicit drug use (other than cannabis) among students in urban versus rural settings were mixed, with only three out of the eight surveys finding that students who attended rural schools were more likely to report this outcome. Prescription drug abuse did not vary appreciably by setting as only one out of seven surveys observed a significant effect. None of the eight surveys drawn on for this report found that urban students were more like to report any of the outcomes explored.
The current report has implications for the way communities and schools in rural settings address youth alcohol use and associated risk behaviour prevention. School boards might want to ask if rural students have equal access to the treatment and prevention resources and services available to their urban counterparts. Further research might explore if it is beneficial to provide additional or specialized training for those responsible for youth drug use prevention services in rural settings. The question of access for rural youth to services and resources for risky substance use should be asked to determine if alternative treatment and prevention methods of delivery might be beneficial in rural schools. Some studies have suggested that increased substance use among rural youth could be due to limited access to drug education and treatment services that might be available in more populated centres (Conger, 1997; DeVoe, Krois, & Stenger, 2009). Other recommendations include examining the infrastructure of rural communities to assess whether disparities exist between these communities and urban settings with respect to part-time job opportunities, sport, music, clubs and so on. Building capacity within communities to enhance various protective factors (e.g., extracurricular activities) and to limit risk factors (e.g., negative social influences) should always be considered in initiatives aimed at preventing youth substance use (Canadian Centre on Substance Abuse, 2010; United Nations Office on Drugs and Crimes, 2013). It would also be helpful to examine further how students travel from parties, schools and other events in an effort to assess what can be done to support easier access to safe transportation for rural youth. Finally, engaging youth in the development of preventive approaches might provide the most effective way to initiate change. These suggestions are speculative and further evidence is required to determine the effectiveness of these approaches in preventing or reducing substance use and associated risky behaviours among rural students. While rural students appeared to be at greater risk of reporting substance use and risk behaviours as compared to urban students, urban students continue to use substances and the need to improve prevention efforts for all youth remains.
Conclusions and Next Steps
Together, national and provincial data indicate that students who attend schools in rural settings are at increased likelihood of reporting certain outcomes related to substance use, predominantly those pertaining to alcohol use and associated risk behaviours. Longitudinal data are needed to determine whether the differences in rural student substance use and risky behaviours observed in this report are linked to later health disparities in urban versus rural communities. These findings are an essential first step towards obtaining a cross-Canada picture of urban-rural student differences and point to key areas where drug prevention strategies could be tailored for rural youth.