Rural, suburban, and urban variations in alcohol consumption in the United States: findings from the National Epidemiologic Survey on Alcohol and Related Conditions.
BACKGROUND
Alcohol consumption is a major public health problem nationally, but little research has investigated drinking patterns by rurality of residence.


OBJECTIVE
To describe the prevalence of abstinence, alcohol use disorders, and risky drinking in rural, suburban, and urban areas of the United States.


METHODS
Analyses of the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were conducted to estimate prevalence rates for abstinence, a current alcohol use disorder, and exceeding recommended daily and weekly drinking limits. Logistic regression analyses were conducted to test for rural and urban versus suburban differences after adjusting for potential confounders. Additional analyses were stratified by Census Region.


RESULTS
Nationally, the odds of abstinence and, among drinkers, the odds of a current alcohol disorder and exceeding daily limits were higher in rural than suburban areas. Stratified analyses revealed differences in the associations between rurality of residence and drinking across Census Regions. Rural residents of the Northeast, Midwest, and South and urban residents of the Northeast had higher odds of abstinence than their suburban peers. Among drinkers, rural and urban residents of the Midwest had higher odds of a current alcohol disorder and exceeding daily limits; urban residents of the Midwest had higher odds of exceeding weekly limits.


CONCLUSIONS
Abstinence is particularly common in the rural South, whereas alcohol disorders and excessive drinking are more problematic in the urban and rural Midwest. Health policies and interventions should be further targeted toward those places with higher risks of problem drinking.
Borders
Tyrone F
TF
Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. tfborders@uams.edu
Booth
Brenda M
BM
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D003625:Data Collection; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D013383:Suburban Population; D014481:United States / Q000453:epidemiology; D014505:Urban Population