The findings show that the level of drug use among rural adolescents is at a high level, and rural adolescents use a variety of drugs and, like their urban counterparts, use multiple drugs. Students at highest risk for illegal drug use are those who have more friends/peers who use drugs. The acceptance and use of substances by parents is related to their adolescent children's drug use. Further, media, teachers, and peers have been found to be important sources of drug information for rural adolescents. Studies also show that drug use and initiation patterns can be different for various racial/ethnic and cultural groups of adolescents. A separate section of this chapter focuses on drug use in Appalachian Kentucky. Appalachians represent a distinct group on the basis of their history, economy, culture, and service availability. The community environment within which adolescents grow up is important when developing alcohol and other drug prevention programming, as noted in the description of Appalachian Kentucky. 81 references