Academic journal article Alcohol Research: Current Reviews

Alcohol Use Patterns among Urban and Rural Residents: Demographic and Social Influences

Academic journal article Alcohol Research: Current Reviews

Alcohol Use Patterns among Urban and Rural Residents: Demographic and Social Influences

Article excerpt

Rates of alcohol use and alcohol use disorder (AUD) vary with geographic location. Research on risks for AUD associated with living in a rural versus urban setting is complicated by the varied systems used to classify geographic location. Studies comparing the prevalence of heavier or binge drinking and AUD based on a dichotomous urban/rural classification have mixed findings when compared with those using more detailed urban-to-rural categories. In addition, urban/rural residence interacts with other demographic factors such as age, U.S. region, and race/ethnicity to affect alcohol use. Social and cultural factors help explain the relationship between geographic location and alcohol use. However, this area of research could be improved by the use of standardized definitions as well as the analysis of a more complete urban-to-rural continuum (e.g., urban, suburban, and rural areas). Having a better understanding of how geographic characteristics influence alcohol use would help inform and improve prevention and treatment efforts.

Key words: Alcohol use, abuse, and dependence; alcohol use patterns; alcohol use disorder; geographic location; urban society; rural society; risk and protective factors; demographic risk and protective factors; cultural risk and protective factors; environmental risk and protective factors; social influences


Geographic location can be an important factor in determining a person's level of risk for alcohol-related problems. Certain factors associated with living in an urban or rural area may increase risk, while others may be protective. For example, the availability of alcohol, norms for acceptable drinking behaviors, demographic characteristics, and economic factors all vary with respect to geographic area and may influence drinking behaviors. The National Institute on Alcohol Abuse and Alcoholism's (NIAAA) Health Disparities Strategic Plan 2009-2013 (NIAAA 2009) recognized that differences exist due to location and called attention to addressing the impacts of alcohol use and its consequences on rural populations. This article represents a partial response to that call and examines rates of alcohol use and alcohol use disorder (AUD) in urban versus rural locations. Consideration is also given to how U.S. region, race/ethnicity, and age intersect with these drinking patterns, as well as other social and cultural factors that characterize place of residence. Both government documents and peer-reviewed journal articles were used to examine this topic. This article considers how more delineated categories on an urban-to-rural continuum could better characterize the relationships between geographic location, alcohol consumption, and AUD and improve prevention and treatment efforts.

Definitions of Urban versus Rural Population Areas

Defining and characterizing urban and rural population areas can he a complicated task. There are over two dozen definitions of "rural" used by U.S. government agencies (Bucholtz 2008). Three examples of such definitions are presented in table 1. These definitions have been applied in alcohol studies (with some of the related results reviewed in this article) and have implications for defining the percentage of the U.S. population that live in an urban versus a rural area. For example, according to the U.S. Census Bureau (USCB) and using its urban area, urban cluster, and rural area classifications, approximately 80.7 percent of the U.S. population in 2010 lived in an urban community, with the remainder (19.3 percent) living in a rural area (USCB 2013). The Office of Management and Business (OMB) employs a different 3-group urban-to-rural classification (OMB 2010, 2013), which defines Core Based Statistical Areas (CBSA) as metropolitan, micropolitan, or non-core based. The CBSA classification has been used to define a rural area in two ways: (1) living outside of both a metropolitan and a micropolitan county, or (2) only living outside of a metropolitan county. …

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