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Net of multiple risk and protective factors, rural adolescents have 35% greater odds and small urban adolescents have 21% greater odds of past\u2010year POM compared to large urban adolescents. The difference between rural and small urban adolescents was not significant. Criminal activity, lower perceived substance use risk, and greater use of emergency medical treatment partially contribute to higher odds among rural adolescents, but they are also partially buffered by less peer substance use, less illicit drug access, and stronger religious beliefs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Researchers, policy makers, and treatment providers must consider the complex array of individual, social, and community risk and protective factors to understand rural\/urban differences in adolescent POM. Potential points of intervention to prevent POM in general and reduce rural disparities include early education about addiction risks, use of family drug courts to link criminal offenders to treatment, and access to nonemergency medical services to reduce rural residents\u2019 reliance on emergency departments where opioid prescribing is more likely.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12141","type":"journal-article","created":{"date-parts":[[2015,9,7]],"date-time":"2015-09-07T02:14:40Z","timestamp":1441592080000},"page":"204-218","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":124,"title":["Examining Rural\/Urban Differences in Prescription Opioid Misuse Among US Adolescents"],"prefix":"10.1111","volume":"32","author":[{"given":"Shannon M.","family":"Monnat","sequence":"first","affiliation":[{"name":"Department of Agricultural Economics, Sociology, and Education and The Population Research Institute The Pennsylvania State University  University Park Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khary K.","family":"Rigg","sequence":"additional","affiliation":[{"name":"Department of Mental Health Law &amp; Policy, Louis de la Parte Florida Mental Health Institute University of South Florida  Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,9,6]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1406143"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2011.01075.x"},{"key":"e_1_2_7_4_1","unstructured":"Centers for Disease Control and Prevention. 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