Academic journal article Alcohol Research

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

Academic journal article Alcohol Research

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

Article excerpt

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 be 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 classifica- tions, 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 urbanto-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. Based on these two definitions, in 2010 approximately 6.3 percent or 16.3 percent of Americans, respectively, lived in a rural area (Mackun and Wilson 2011). The United States Department of Agriculture (USDA), through the Economic Research Service (ERS), has also developed multiple methods of categorizing non-metropolitan counties, one of which is referred to in table 1 (USDA 2013b). According to the USDA denition of metropolitan versus non-metropolitan areas, in 2012, approximately 14.7 percent of the U.S. population lived in a non-metropolitan area (USDA 2013a).

These definitions exemplify the potential difficulties involved in defining urban or rural settings, and the possibility of organizing geographic data into categories based on a variety of urban/rural thresholds. These varied definitions complicate the study of how urban and rural areas are associated with patterns of alcohol use in the United States. For example, population estimates of alcohol use and AUD from the Substance Abuse and Mental Health Services Administration annual household surveys (from 1971 to 2001 called the National Household Survey on Drug Abuse [NHSDA], and from 2002 to the present called the National Survey on Drug Use and Health [NSDUH]) cannot be readily compared across urban and rural categories. The NHSDA defined urban and rural residence through a dichotomous metropolitan versus non-metropolitan classification using OMB definitions (SAMHSA 2003a), whereas the NSDUH uses the expanded 9-category classification based on the Rural/Urban Continuum Codes (RUCC) and updated OMB standards for defining a metropolitan area. …

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