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Rural high school youth living in the country or on farms were exposed to fewer school protective factors (i.e., opportunities and rewards for prosocial involvement) and higher school risk factors (i.e., academic failure and low commitment 2024 Surgeon General Report to school) versus youth living in towns School risk factors were strongly associated with greater odds of lifetime and current smokeless tobacco use among high school and middle school students across rural contexts

Retrieved 12 March 2022