title: Alcohol consumption among urban, suburban, and rural Veterans Affairs outpatients.
abstract: OBJECTIVE
  United States rural residents tend toward poorer health than urban residents. Although alcohol use is associated with multiple medical conditions and can be reduced via brief primary care-based interventions, it is unknown whether alcohol consumption differs by rurality among primary care patients. We sought to describe alcohol consumption among urban, suburban, and rural Veterans Affairs (VA) outpatients.
  
  
  METHODS
  Outpatients from 7 VA facilities responded to mailed surveys that included the validated Alcohol Use Disorders Identification Test Consumption (AUDIT-C) screening questionnaire. The ZIP code approximation of the US Department of Agriculture's rural-urban commuting area (RUCA) codes classified participants into urban, suburban, and rural areas. For each area, adjusted logistic regression models estimated the prevalence of past-year abstinence among all participants and unhealthy alcohol use (AUDIT-C ≥ 3 for women and ≥ 4 for men) among drinkers.
  
  
  RESULTS
  Among 33,883 outpatients, 14,967 (44%) reported abstinence. Among 18,916 drinkers, 8,524 (45%) screened positive for unhealthy alcohol use. The adjusted prevalence of abstinence was lowest in urban residents (43%, 95% CI 42%-43%) with significantly higher rates in both suburban and rural residents [45% (44%-46%) and 46% (45%-47%), respectively]. No significant differences were observed in the adjusted prevalence of unhealthy alcohol use among drinkers.
  
  
  CONCLUSIONS
  Abstinence is slightly more common among rural and suburban than urban VA outpatients, but unhealthy alcohol use does not vary by rurality. As the VA and other health systems implement evidence-based care for unhealthy alcohol use, more research is needed to identify whether preventive strategies targeted to high-risk areas are needed.
authors.affiliation: Health Services Research & Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington 98101, USA. emily.williams3@va.gov
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.forename: Lynne V
authors.initials: LV
authors.lastname: McFarland
authors.forename: Karin M
authors.initials: KM
authors.lastname: Nelson
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*; D013383:Suburban Population / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014505:Urban Population / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*