College Years Research Articles

Longitudinal associations between sense of belonging, imposter syndrome, and first-year college students’ mental health

Objective: The first year of college is a time of major changes in social dynamics, raising questions about ways to promote students’ mental health. We examined longitudinal associations between students’ sense of belonging, imposter syndrome, depressive symptoms, and well-being. Participants: Fifty-eight first-year college students at a university in the United States participated in the study. Methods: Students completed questionnaires during the first 6 months of college (T1) and at the end of the academic year (T2). Results: Greater sense of social and academic belonging was correlated with lower imposter syndrome, depression, and greater well-being at T1. Accounting for T1 measures, lower imposter syndrome predicted greater well-being but not depression at T2. Accounting for T1 mental health, belonging was not a significant predictor of depression or well-being at T2. Conclusion: Increasing sense of belonging and addressing imposter syndrome early in the transition to college may be critical in promoting mental health.

Unpacking the Paradox: Understanding the Gap Between Perceived and Actual Competence in LGBTQ+ Health Care.

Awareness about existing health disparities affecting sexual minorities remains insufficient, and nursing professionals often lack self-awareness about their biases and assumptions concerning lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) individuals. To explore how exposure to the LGBTQ community, during both classroom and clinical experiences, relates to nursing students' confidence in providing culturally congruent care to this group. This nonexperimental correlational study occurred at a Midwest 4-year public university, involving final-semester baccalaureate nursing students who completed demographic and educational preparation surveys regarding their confidence in providing health care to the LGBTQ population. Results indicate that participants with no direct care experience were more confident in their communication skills and culturally congruent patient care for sexual minorities compared to those exposed to sexual minorities in clinical settings. Nursing students' perceptions and experiences in delivering culturally congruent health care to sexual minorities provide an interesting perspective for examining the Dunning-Kruger effect.

Students as partners for effective change

My journey as a student partner began in the summer of 2020, amidst overwhelming COVID-19 hysteria and an opportunity to explore a new kind of online learning. I was doing research with a professor of mine and invited to a workshop about Pedagogical Partners with Alison Cook-Sather. When I learned how impactful my work could be as a student partner, I was hooked. For many years, I had felt as though students were not listened to, heard, or respected. I wanted students to be able to play an active role in their own learning. My freshman year, I became an undergraduate teaching assistant (UTA). The experience truly changed my college experience - I mended my troubled relationship with school and learning and came to love it. Now, in my final year of college, I’ve been a UTA every semester since my freshman year. I’ve done research on the number of UTAs across the country and on campus at Syracuse University (SU). At SU, UTAs were few and far between, just about 10% of classes had one. The most common answer as to why UTAs weren’t used was that there was no money to pay them, so I created my own class that gave students 3 credits to be a UTA and partnered up with two close faculty mentors of mine to teach it. We reflected, dished out advice, and made important bonds with faculty and each other. After one very successful semester, we combined with the Partnership for Inclusive Education (PIE) Program through the Center for Teaching and Learning Excellence to merge the UTA program with a student consultant program. This semester, I am enjoying the best of both worlds as a UTA as well as a lead student consultant. Over the course of my college career, I have learned what a true partnership means, experienced the two-way learning it provides, and worked to make courses more inclusive, understanding, and student-centered. I’ve fought hard to put students in decision-making roles and mentored countless students into fantastic student partners that have changed campus for the better.

Belonging Interrupted: Toward an Understanding of How Virtual Learning Impedes Women Students’ Belonging in Engineering

Although the effects of COVID-19 were felt by all students, the pandemic exacerbated the barriers to belonging for women in engineering. Little work to date has investigated women’s experiences during the pandemic in disciplines that are hallmarked by masculinity. What scholarship has been completed on pandemic-necessitated virtual instruction has not examined how women’s experiences and sense of belonging differed by the college year in which this disruption in their learning environment occurred. Utilizing data from seven focus groups conducted in March 2022 with 22 students, this study investigates how pandemic-induced virtual instruction is related to sense of belonging for women within their engineering majors. We found not only that the disruption caused by the pandemic had differential outcomes for students, but that these differences were mainly related to the year in which pandemic-induced virtual instruction occurred. This study highlights the importance of focusing on belonging and related issues as women transition into their major. We offer implications and recommendations for practice and research based on the differential outcomes found.

The comorbidity mechanism of problematic internet use and depression among Chinese college students: A cross-lagged panel network analysis

Problematic internet use (PIU) and depression usually co-occur and are common among college students. According to network theory, it may be attributed to the interplay of symptoms that connect these two mental health problems. However, most studies have failed to examine complex and subtle connections at the symptom level and have not clarified how PIU and depression symptoms are intercorrelated, which symptoms serve as the source of comorbidity (i.e., the central symptoms), and whether such a comorbidity mechanism would change with higher grades. To explore these questions, this study examined four contemporaneous networks and three cross-lagged panel networks, visualizing the symptoms as nodes and the connections between symptoms as edges. A total of 2,420 college students (Mage = 18.35, SD = 0.84; 67.98 % girls) completed four annual surveys. Overall, the results of contemporaneous networks and cross-lagged panel networks indicated that (a) PIU and depression symptoms are intercorrelated; (b) the core symptoms responsible for comorbidity mostly belonged to PIU, and (c) the comorbidity mechanism would change with time. These findings explain the dynamic relation between PIU and depression and identify possible primary symptoms that comorbidity programs can mitigate at different stages of the college years.

Creation of a sexual risk index from the American College Health Association-National College Health Assessment (ACHA-NCHA) III to compare nontraditional and traditional student sexual risk

Objective To examine the utility of a novel sexual risk index (SRI) to better use National College Health Assessment (NCHA) sexual health-related questions. Methods The first phase included discussions, testing, and recoding of the initial set of items. In the second phase, a correlation analysis was run; items were systematically removed to achieve a Cronbach’s alpha of .714. Results All currently enrolled students in Spring 2020 at medium-sized, 4-year public university in Florida were recruited (n = 4,850) for the NCHA. Of the 441 total respondents, 223 students were included in the SRI analyses. Most had very low SRI scores, indicating few sexual risks. Nontraditional students were half as likely to experience academic challenges as compared to traditional students (TS; OR = .487, p = .033), while increasing SRI scores (OR = 1.182, p = .022) and decreasing GPA scores (OR = −1.975, p < .001) were associated with an increased likelihood of self-reporting academic challenges. Conclusions Results suggest high utility and reliability of the SRI. The use of the SRI provides a better overall picture of sexual risk-taking through a score rather than comparison of individual NCHA items.

Discovering generation Z's level of principled moral reasoning and assessing demographic variations

AbstractFramed by social identity and cognitive moral reasoning theories, this paper assessed Gen Zs' level of principled moral reasoning, discovered during their undergraduate college years, and influences revealed by demographic variations using the Moral Reasoning Inventory. We discovered that Gen Zs' principled moral reasoning was lower than research reporting on Millennials, but not as dramatic a decline as scholars reported when investigating Baby Boomers, Generation Xers, and Millennials' Pscores. We found some differences within our sample based on business discipline (academic major), the most powerful influence on Gen Zs' principled moral reasoning, followed by gender, work experience, and academic intelligence (GPA). Years in an academic program were not seen as influencing Gen Zs' principled moral reasoning. Overall, we conclude that Gen Zs may not exhibit a homogenous ethical identity as measured by their level of principled moral reasoning. Implications of these findings are discussed.

The Long and Winding Road: Mapping the College and Employment Pathways to Teacher Education Program Completion in Washington State

Nationally, more than 75% of individuals who are credentialed to teach are prepared in traditional college- or university-based teacher education programs (TEPs). But the college and employment pathways that prospective teachers take to TEP enrollment and completion have not been comprehensively examined. A better understanding of how credentialed individuals find their way into TEPs helps us understand the sources of new teacher supply early in the prospective teacher pipeline. With that in mind, we analyze pathways into and through TEPs using historical postsecondary and unemployment insurance data from Washington State. We find that the pathways are quite varied, with around 40% of bachelor’s-level TEP completers spending at least some time in community colleges and fewer than 40% enrolling and finishing at the same university directly after high school. Pathways to master’s TEP completion are even more varied, with almost half of the completers having prior employment experience. For researchers, this varied landscape raises important questions about the relationship between pathways, candidate persistence, and eventual job performance. For policymakers, the results suggest that efforts to recruit the next generation of teachers need to look beyond the pool of students already enrolled at a 4-year university to include students at 2-year colleges or in the labor force who might be interested in entering a TEP.

An identity-based learning community intervention enhances the lived experience and success of first-generation college students in the biological sciences

Working-class first-generation (FG) college students are underrepresented in higher education and STEM. Using a longitudinal quasi-experiment, we tested the impacts of a living learning community (LLC) in the biological sciences on FG students in their first year of college (Semester 1: N = 243; Semester 2: N = 199), across three cohorts (2018–2019, 2019–2020 and 2020–2021). Participation in the LLC enhanced FG students’ belonging, confidence, motivation, grades, knowledge of the social relevance of biology, and reduced STEM anxiety compared to a control group of FG students not in an LLC. LLC participation also increased retention in biological science majors one-year post-intervention compared to the control FG group. Moreover, LLC participation closed the academic gap between FG students in the LLC and honors students from college-educated families in a separate honors LLC. Benefits of the LLC intervention remained stable despite the COVID-19 pandemic, when living together became impossible, producing positive effects across cohorts from pre-pandemic to in-pandemic. Our results suggest that affinity-based learning communities—with or without shared housing—in the transition to college enhance academic thriving, persistence, and reduce social class driven achievement gaps in STEM.

Exploring Decisional Conflict Experienced by Individuals Considering Metoidioplasty and Phalloplasty Gender-affirming Surgery.

Metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) is increasingly performed and requires patients to make complex decisions that may lead to decisional uncertainty. This study aimed to evaluate decisional conflict in individuals considering MaPGAS. We administered a cross-sectional survey to adult participants assigned female sex at birth and considering MaPGAS, recruited via social media platforms and community health centers. We collected data on demographics, medical and surgical history, MaPGAS type considered, and the Decisional Conflict Scale (DCS). DCS scores range from 0 to 100 (>37.5 indicates greater decisional conflict). Demographic characteristics and DCS scores were compared between subgroups, using descriptive and chi-square statistics. Participants commented on MaPGAS uncertainty, and their comments were evaluated and thematically analyzed. Responses from 264 participants were analyzed: mean age 29 years; 64% (n = 168) trans men, 80% (n = 210) White, 78% (n = 206) nonrural, 45% (n = 120) privately insured, 56% (n = 148) had 4 or more years of college, 23% (n = 84) considering metoidioplasty, 24% (n = 87) considering phalloplasty, and 26% (n = 93) considering metoidioplasty and phalloplasty. DCS total scores were significantly higher (39.8; P < 0.001) among those considering both MaPGAS options, as were mean ratings on the Uncertainty subscale [64.1 (SD 25.5; P < 0.001)]. Concerns surrounding complications were the top factor contributing to uncertainty and decisional conflict. In a cross-sectional national sample of individuals seeking MaPGAS, decisional uncertainty was the highest for those considering both MaPGAS options compared with metoidioplasty or phalloplasty alone. This suggests this cohort would benefit from focused decision support.

Transdermal alcohol concentration features predict alcohol-induced blackouts in college students.

Alcohol-induced blackouts (AIBs) are common in college students. Individuals with AIBs alsoexperienceacute and chronic alcohol-related consequences. Research suggests that how students drink is an important predictor ofAIBs. We used transdermal alcohol concentration (TAC) sensors to measure biomarkers of increasing alcohol intoxication (rise rate, peak, and rise duration) in a sample of college students. We hypothesized that the TAC biomarkers would be positively associated with AIBs. Students were eligible to participate if they were aged 18-22 years, in their second or third year of college, reported drinking 4+ drinks on a typical Friday or Saturday, experienced ≥1 AIB in the past semester, owned an iPhone, and were willing to wear a sensor for 3 days each weekend. Students (N = 79, 55.7% female, 86.1% White, Mage = 20.1) wore TAC sensors and completed daily diaries over four consecutive weekends (89.9% completion rate). AIBs were assessed using the Alcohol-Induced Blackout Measure-2. Logistic multilevel models were conducted to test for main effects. Days with faster TAC rise rates (OR = 2.69, 95% CI: 1.56, 5.90), higher peak TACs (OR = 2.93, 95% CI: 1.64, 7.11), and longer rise TAC durations (OR = 4.16, 95% CI: 2.08, 10.62) were associated with greater odds of experiencing an AIB. In a sample of "risky" drinking college students, three TAC drinking features identified as being related to rising intoxication independently predicted the risk for daily AIBs. Our findings suggest that considering how an individual drinks (assessed using TAC biomarkers), rather than quantity alone, is important for assessing risk and has implications for efforts to reduce risk. Not only is speed of intoxication important for predicting AIBs, but the height of the peak intoxication and the time spent reaching the peak are important predictors, each with different implications for prevention.

Navigating college campuses: The impact of stress on mental health and substance use in the post COVID-19 era

The college years are one of excitement and often thought of as a dream like setting of growth, creativity, and independence. This exciting time can be marred by the onset or exacerbation of mental health conditions, alcohol, and/or drug dependence. This writing looks to explore the world of college mental health and the changes the provisions of this type of care has undergone during and after the COVID-19 pandemic. We look at the staggering rates of diagnosed mental health diagnoses and mental health related symptoms that may undermine a student's ability to meet their full growth and academic potential. We look to explore different health settings where college age students are accessing care and how that care is being delivered (e.g. community vs on-campus, telehealth vs in-person). We also aim to highlight specific mental health conditions (e.g. anxiety, depression, suicidality, PTSD) and specific student stressors (e.g. participating in athletics, socioeconomic pressures) to underscore the message that the mental health of college age students is an area that needs continued study and engagement of all parties involved in student development and well-being.

Early Clinical Simulation Exposure May Enhances Academic Performance of Medical Students: A Quasi-Experimental Study in Saudi Arabia

Purpose: The traditional medical curriculum in Saudi Arabia needs to undergo major reforms to make it more student-centric, relevant, interesting and contemporary. This unmet need can be fulfilled by the use of “Early Clinical Exposure “(ECE) techniques, employed via simulation based medical education (SBME) courses, integrated into the medical curriculum. This study delivered ECE via SBME, to third year pre-clinical students, and assessed its impact on their fourth-year academic scores. Materials and Methods: SBME modules designed by expert faculty members were delivered through a peer-assisted learning model, spread over a three-week period, at a well-equipped medical simulation laboratory at our teaching hospital, in Jeddah, Saudi Arabia. Students who attended this SBME intervention were tracked for their performance in their fourth year, versus the control group. Result: Of the 401 third year students included in the study, only 30.2% consented to attend the SBME course, while 69.8% comprised the control group. The overall study population obtained a mean score of 40.27 in the fourth-year final examination. The male and female students who attended the SBME module obtained a statistically significantly higher mean score versus the non-attendees (p=0.0018). Among the SBME course attendees, no statistically significant difference was noted between the scores of males and females (p=0.187). Conclusion: SBME exposure during the pre-clinical years has a significantly positive impact on the performance of students, in the core clinical years at medical college. It holds promise in reducing redundancies in medical education, making medical studies more interesting, relevant, contemporary and practical. It facilitates seamless transition of students from pre-clinical to clinical years in medical college. Implementation of early SBME courses at the pre-clinical level, mandated and supported by government initiatives, would be a huge step forward in the medical education in Saudi Arabia.

The experiences of undergraduate nursing students with mental health conditions in the inpatient clinical setting: A qualitative study

BackgroundThe prevalence of mental health conditions in college students is increasing. Due to this rising number, more students with mental health conditions (NSWMHCs) are enrolling in nursing programs. There is a need for nurse educators to discover new ways to foster retention and success for this student population. ObjectivesThe purpose of this study was to examine the experiences of undergraduate NSWMHCs in the inpatient clinical setting, particularly related to perceived barriers and changes they would make to their clinical rotations. DesignQualitative descriptive design. SettingThe study was conducted at a 4-year public university in the Northeast region of the United States. ParticipantsA purposeful sample of seven junior and senior undergraduate nursing students diagnosed with mental health conditions. MethodsData were collected between November 2021 and February 2022 through in-depth, semi-structured interviews that lasted between 30 and 60 min each. Data were analyzed using thematic analysis. ResultsThe data analysis identified seven major themes: dealing with internal and external barriers, relating to patients' experiences particularly those with mental health conditions, sharing perceptions with peers to understand interactions and experiences, using particular coping skills, improving over time, inconsistent faculty interactions, and recommended changes. ConclusionsFindings suggest that while NSWMHCs face multiple challenges in the clinical setting, they also have valuable experiences and possess unique insight that can foster their success.

The Role of Interactive Media in Promoting Moral Values among the Students of the University of Jordan from their point of view

The study aimed at identifying the role of interactive media in enhancing moral values ​​among the students of the University of Jordan from their point of view, and the differences for the estimations of the sample regarding the role of interactive media attributed to the variables of the study (gender, college, and academic year). The researchers used the descriptive correlational methodology. The study population consisted of (4000) students, a simple random sample of (815) students was drawn from the population. The tool of the study composed of a questionnaire to measure the role of interactive media in promoting moral values among the students. The results showed that the role of interactive media in enhancing moral values among the students of the University of Jordan was moderate. Moreover, the results also showed that there were no significant differences for the estimations of the sample subjects regarding the role of interactive media in enhancing moral values among the students of the University of Jordan, which are attributed to the variables of gender, collage, and academic year. The study recommended establishing the values of self-censorship and supporting moral values through socialization.

문제중심학습(PBL) 기반 유아수학교육 수업이 예비유아교사의 수학교수효능감, 수학적 태도 및 문제해결능력에 미치는 영향

The purpose of this study is to examine the impact of Problem Based Learning(PBL)-based early childhood mathematics education classes on pre-service early childhood teachers’ mathematics teaching efficacy, mathematical attitude, and problem-solving ability. The study participants were 38 pre-service early childhood teachers attending a 4-year university in G City. The PBL-based early childhood mathematics education class used a combination of lecture-based and problem-based learning methods, and problem-based learning consisted of four PBL problems and was conducted for a total of 9 weeks. The research tools used were mathematics teaching efficacy, mathematical attitude, and problem-solving ability before and after. Data analysis was performed using a paired samples t-test using the SPSS 28 program. As a result of the study, PBL-based early childhood mathematics education classes were found to have a positive impact on improving the mathematics teaching efficacy, mathematical attitude, and problem-solving ability of pre-service early childhood teachers. Through this, the significance of the study is that it presented and verified a PBL-based mathematics teaching model that can be applied to the early childhood mathematics education classes of pre-service early childhood teachers.

Bridging Gaps in Teaching and Learning Biochemistry: A Qualitative Study

Objective: To identify the sources of learning gaps in biochemistry teaching and learning and explore new teaching and learning strategies, considering the students' perceptions and felt needs. Study Design: Exploratory qualitative study (Social-constructivist philosophical worldview). Place and Duration of Study: Public Sector Medical College, Pakistan, from Jul 2020 to Jul 2021. Methodology: Students from all five years of medical college were recruited voluntarily after their written consent. Ten focus group discussions were conducted, each consisting of approximately 8 to 12 participants. Each session was recorded and then later transcribed verbatim. Verbatim FGDs were reviewed, and codes were given as the concept became recognizable. A code structure was developed via an inductive approach, and then sub-themes and themes were generated. Results: Ten major themes were generated from the FGDs. These themes were teaching, students’ motivation, clinical irrelevance, educational needs, transition difficulty, attitudes, student support, senior peers, curriculum coherence, and assessment. These themes were further elucidated to explain the causes of the learning gaps and provide suggestions. Conclusion: This study concludes that teaching, students’ motivation, clinical irrelevance, educational needs, difficulty in transition, student attitude, student support, senior peers, curriculum coherence, and assessment are the potential sources of the learning gap to achieve intended learning outcomes of biochemistry for medical students.

Process Evaluation and Investigation of Cultural Adaptations for an Online Parent-Based Intervention Using a Mixed-Method Approach

Most alcohol intervention research focuses on program efficacy, yet few studies have investigated the acceptability of a program’s design and implementation to the target population or adapting existing alcohol interventions to different populations. To address these gaps in the literature, we (1) examined participant responsiveness to and implementation quality of FITSTART+, a web-app delivered parent-based alcohol intervention designed for incoming first-year college students in the United States, and (2) gathered feedback on how this intervention could be adapted to other populations of parents. A sample of U.S. parents of 17–20-year-old first-year college students (N = 109) participated in FITSTART+ during their child’s first year of college and completed a survey about parents’ responsiveness to the app and its quality. Next, a sample of non-U.S. parents of adolescents aged 13 to 19 (N = 44) participated in one of 11 focus groups in which they briefly explored the app and then discussed how it could be adapted to be applicable and culturally relevant for them and their context. Results revealed that U.S. parents rated the intervention’s quality as high and parents were responsive to the web-app’s content, but some did not visit one of the most critical aspects of the intervention (i.e., alcohol-related parenting resources). Non-U.S. participants provided a range of suggestions for adapting the intervention to their context, which varied by culture. Results identify areas for improvement, particularly regarding the use of alcohol-related parenting resources, in this intervention and for web-delivered PBIs more broadly.

Patient and Health Care Professional Perspectives About Referral, Self-Reported Use, and Perceived Importance of Digital Mental Health App Attributes in a Diverse Integrated Health System: Cross-Sectional Survey Study.

Digital mental health applications (DMHAs) are emerging, novel solutions to address gaps in behavioral health care. Accordingly, Kaiser Permanente Mid-Atlantic States (KPMAS) integrated referrals for 6 unique DMHAs into clinical care in 2019. This study investigated patient and health care professional (HCP) experiences with DMHA referral; DMHA use; and perceived importance of engagement, functionality, design, and information attributes in real-world practice. Separate cross-sectional surveys were developed and tested for patients and HCPs. Surveys were administered to KPMAS participants through REDCap (Research Electronic Data Capture), and completed between March 2022 and June 2022. Samples included randomly selected patients who were previously referred to at least 1 DMHA between April 2021 and December 2021 and behavioral health and primary care providers who referred DMHAs between December 2019 and December 2021. Of the 119 patients e-mailed a survey link, 58 (48.7%) completed the survey and 44 (37%) confirmed receiving a DMHA referral. The mean age of the sample was 42.21 (SD 14.08) years (29/44, 66%); 73% (32/44) of the respondents were female, 73% (32/44) of the respondents had at least a 4-year college degree, 41% (18/44) of the respondents were Black or African American, and 39% (17/44) of the respondents were White. Moreover, 27% (12/44) of the respondents screened positive for anxiety symptoms, and 23% (10/44) of the respondents screened positive for depression. Overall, 61% (27/44) of the respondents reported DMHA use for ≤6 months since referral, 36% (16/44) reported use within the past 30 days, and 43% (19/44) of the respondents reported that DMHAs were very or extremely helpful for improving mental and emotional health. The most important patient-reported DMHA attributes by domain were being fun and interesting to use (engagement); ease in learning how to use (functionality); visual appeal (design); and having well-written, goal- and topic-relevant content (information). Of the 60 sampled HCPs, 12 (20%) completed the survey. Mean HCP respondent age was 46 (SD 7.75) years, and 92% (11/12) of the respondents were female. Mean number of years since completing training was 14.3 (SD 9.94) years (10/12, 83%). Of the 12 HCPs, 7 (58%) were physicians and 5 (42%) were nonphysicians. The most important HCP-reported DMHA attributes by domain were personalized settings and content (engagement); ease in learning how to use (functionality); arrangement and size of screen content (design); and having well-written, goal- and topic-relevant content (information). HCPs described "typical patients" referred to DMHAs based on perceived need, technical capability, and common medical conditions, and they provided guidance for successful use. Individual patient needs and preferences should match the most appropriate DMHA. With many DMHA choices, decision support systems are essential to assist patients and HCPs with selecting appropriate DMHAs to optimize uptake and sustained use.

Alcohol Use Amongst Rural Adolescents and Young Adults: A Brief Review of the Literature.

The sociodevelopmental periods of adolescence and young adulthood are rife with alcohol use. However, much of the literature demonstrating this comes from 'traditional' settings and college campuses (i.e., large suburban/urban campuses, or those containing their own infrastructure). Alcohol culture in rural areas has largely been understudied, which may be problematic given the unique stressors they face (e.g., economic hardship, lack of social activities, healthcare inequality). There has also been difficulty both within and across fields classifying rural versus urban geographical locations; no distinct system used broadly, making ittrea difficult to generalize and accurately collect data. The geographic categorizations are often viewed as homogenous identifiers; however, diversity occurs both within and outside of these classification systems. It appears that rurality may be a risk factor for increased drinking both earlier and later in life, but the research has failed to extend to the formative college years. This short review has two main focuses: attempting to disentangle the definition of rurality and reviewing the literature regarding alcohol use in rural areas, with a specific focus on adolescents and young adults. Identifying the mechanisms responsible for substance use in rural areas is a crucial component of prevention and treatment programs.