While some of the problems related to substance abuse and infectious disease issues can occur in any location, there are some identifiable and distinct cultural aspects that influence to a degree our efforts to improve health in rural regions. Some of these rural cultural elements include:

• Stressed primary economic bases
  
  
• Health care access issues due to isolation
  
  
• Limited availability of health and human services due to sparseness of population
  
  
• Hospital-based nature of most services
  
  
• Impact of seasonal employment patterns on continuity of care
  
  
• Lack of linguistically and culturally appropriate services for clients
  
  
• Lack of relevant and consistent training opportunities for providers
  
  
• Lack of awareness and understanding of infectious disease and substance abuse
  
  
• Intergenerational substance abuse patterns and "at risk" family norms