Although alcohol and drug abuse are general problems in America, there is increasing recognition of the need to focus on special populations in which substance abuse magnifies other problems. African-Americans have been particularly vulnerable to the negative social and health consequences associated with substance abuse. For example, in comparison to whites, African-Americans experience an earlier onset of alcoholism and other drug problems, a greater likelihood of being channeled to the criminal justice system rather than to treatment for legal problems caused by substance abuse (Lowe and Alston 1973), higher rates of drug-related homicide deaths (Harper and Dawkins 1977), and a higher rate of illnesses such as liver cirrhosis and esophageal cancer (Franklin 1989). The surge in problems associated with crack cocaine use has compounded the substance abuse problem in the African-American population (Carlson and Siegal 1991).

One-quarter of the population of the United States lives in nonmetropolitan or rural areas (U.S. Congress 1990). These areas are notable for their rich diversity and varied lifestyles. From farming communities in the Midwest, to agricultural areas of the Mississippi Delta, Native American reservations, Appalachian and Ozark Highlands, and western oil-based boom towns, rural communities vary greatly in socioeconomic characteristics, ethnic and minority mix, and availability of health and social services. At the same time, rural communities share a number of characteristics: they are defined by the low population density; most are severely limited in access to professional health, mental health, and substance abuse resources; and rural economies are often volatile in nature with increased dependence on agricultural, extractive, and service industries (Gesler et al. 1992). Higher rates of poverty and substandard housing in rural areas in general and lower educational attainment of rural residents increase

This report presents national estimates of the prevalence of selected risk factors and preventive behaviors related to breast cancer for women 40 years of age and over, Estimates are presented by race and age. Data on preventive practice=breast self-examinations, breast physical examinations, and mammogram=lso are presented within categories of education, income, place of residence, and geographic region, all adjusted for race

Form Approved OMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

The authors thank Dan Zahs for his assistance with data analysis and Joyce Buchanan for her assistance with editing and manuscript This paper reports racial/ethnic differences in the use of licit and illicit drugs, using data from fourteen nationally representative surveys of high school seniors from 1976 through 1989. Throughout the period, Native Americans had the highest prevalence rates for use of illicit drugs except cocaine, for frequent use of alcohol, and for use of cigarettes; White students had the next highest prevalence rates for most drugs. Asian Americans had the lowest prevalence rates, and Black students had prevalence levels nearly as low, except for marijuana. Prevalence rates for the Hispanic groups were mostly in the intermediate ranges, except for a relatively high prevalence of cocaine use among the males. Trend patterns for most forms of drug use have been similar across subgroups, with two notable exceptions: (1) cocaine use increased somewhat more than average among Hispanic seniors and less than average among Black seniors, (2) the proportions smoking cigarettes have declined more sharply among Black than among White seniors, resulting in greater Black-White differences in recent years. Multivariate analyses indicate that subgroup differences in drug use cannot be attributed to background factors such as family

The past decade has seen increasing recognition of the importance of personal health behaviors for the prevention of illness and disability, A pioneer work in this field was a study conducted in Alameda County, Calif., in the mid-