Many researchers have investigated adolescent substance abuse and its increasing prevalence. More recently, substance abuse has emerged as a major public health problem that puts millions of adolescents at increased risk for alcohol related and drug related traffic accidents, the ill effects of sexual practices, poor academic performance, juvenile delinquency, and a stunted developmental process. Although several national surveys indicate that teen use of most illicit drugs has held steady during the past few years, adolescent drug abuse remains alarmingly high. In particular, one population that has received increased attention in recent years is adolescents living in rural areas. Researchers and policy makers concerned about the problems of substance abuse have turned their attention from a singular focus on urban America to also consider special health needs of rural people.