Rural Project Examples Addressing Substance use and misuse

keepin' it REAL Rural

Updated/reviewed March 2024

Need: A drug and alcohol prevention program for middle school students that is specific to rural culture.
Intervention: An adaptation of the evidence-based keepin' it REAL curriculum was customized for rural middle school students.
Results: Students showed a reduction in all substance use and less personal acceptability of substance use.

Updated/reviewed February 2024

Need: Increase medical management knowledge for New Mexico primary care providers in order to provide care for the thousands of rural and underserved patients with hepatitis C, a chronic, complex condition that has high personal and public health costs when left untreated.
Intervention: Project leveraging an audiovisual platform to accomplish "moving knowledge, not patients" that used a "knowledge network learning loop" of disease-specific consultants and rural healthcare teams learning from each other and learning by providing direct patient care.
Results: In 18 months, the urban specialist appointment wait list decreased from 8 months to 2 weeks due to Hepatitis C patients receiving care from the project's participating primary care providers. Improved disease outcomes were demonstrated along with cost savings, including those associated with travel. The project model, now known as Project ECHO® – Extension for Community Healthcare Outcomes — has evolved into a telementoring model used world-wide.

Updated/reviewed January 2023

Need: An approach to support sustained, quality delivery of evidence-based programs for youth and families in rural communities.
Intervention: PROSPER, a program delivery system, guides communities in implementing evidence-based programs that build youth competencies, improve family functioning, and prevent risky behaviors, particularly substance use.
Results: Youth in PROSPER communities reported delayed initiation of a variety of substances, lower levels of other behavioral problems, and improvements in family functioning and other life skills.

Updated/reviewed May 2024

Need: To reduce overdose-related deaths among prescription opioid users in rural Wilkes County, North Carolina.
Intervention: Education and tools are provided for prescribers, patients and community members to lessen drug supply and demand, and to reduce harm in prescription opioid use.
Results: Opioid overdose death rates have decreased in Wilkes County.

Updated/reviewed March 2024

Need: To support parents whose children have been removed from the home so that the parents can make the changes needed for the children to return safely home.
Intervention: A statewide program in Iowa pairs these parents with mentors who have successfully navigated their own child welfare cases.
Results: Participants' children were more likely to return home than non-participants' children and participants were less likely to have another child removal within a year of the child coming home.

Updated/reviewed February 2024

Need: To develop sustainable, community-wide prevention methods for cardiovascular diseases in order to change behaviors and healthcare outcomes in rural Maine.
Intervention: Local community groups and Franklin Memorial Hospital staff studied mortality and hospitalization rates for 40 years in this rural, low-income area of Farmington to seek intervention methods that could address cardiovascular diseases.
Results: A decline in cardiovascular-related mortality rates and improved prevention methods for hypertension, high cholesterol, and smoking.

Updated/reviewed February 2024

Need: Due to West Virginia's high ranking for its use of smokeless tobacco, prevention and cessation education efforts were needed.
Intervention: Development and implementation of the Spit It Out-West Virginia program.
Results: Supported by a 2008-2010 grant allowing the program to be delivered to hundreds of people, 5 workplaces became tobacco free. The program continues to be delivered across the state and reaches hundreds with its face-to-face presentations and thousands with its specific media prevention and cessation messages.

Updated/reviewed May 2023

Need: There is a lack of interventions that addresses teenager behavioral problems, particularly for rural African American adolescents.
Intervention: Rural, locally trained leaders administered five 2-hour meetings for teenagers and their primary caregivers. Trainings focused on reducing risks that prevent positive development, specifically sexual risk-taking that can lead to HIV and other STIs.
Results: Teens reported reduced conduct problems, depressive symptoms, and substance abuse. Families were strengthened, and SAAF-T reduced unprotected intercourse and increased condom efficacy.

Updated/reviewed August 2020

Need: Increase access to medication-assisted treatment for opioid use disorder in rural Vermont.
Intervention: Statewide hub-and-spoke treatment access system.
Results: Increased treatment capacity and care coordination.

Updated/reviewed May 2020

Need: Reduction in the number of emergency department dental patients abusing opioid prescriptions in rural southeastern Maine.
Intervention: Using a one-page opioid prescription guideline, opioid prescribing and emergency room visits for dental pain decreased.
Results: The rate of opioid prescription dropped nearly 20% after implementation, and in comparing the 12-month period before and after implementation, dental pain emergency department visits decreased from 26 to 21 per 1,000.