Rurality, region, ethnic community make-up and alcohol use among rural youth.

PURPOSE: As the most widely used substance among adolescents in the United States, alcohol remains a critical public health issue. The majority of research in this area has focused on individual-level variables. This study examined the contextual effects of rurality, geographic region, and community ethnicity in the prediction of alcohol use among adolescent youth.
METHOD: Participants were 7th-12th grade students from a sample of 260 rural communities across the United States, with oversampling for predominantly Mexican American and African American communities. The total sample comprised 213,225 students. Multilevel modeling was used to estimate both individual and contextual effects for use of alcohol and getting drunk.
FINDINGS: Those living in more rural communities were somewhat more likely to have used alcohol and gotten drunk than their less rural counterparts. Consistent with a trend toward a narrowing gender gap across a number of substances, gender differences in alcohol use were not large, except in the South. A minority in a community, eg, a white student in an African American community, had greater risk for alcohol use and getting drunk.
CONCLUSIONS: Models of alcohol use among rural youth that include only individual-level variables are likely to result in misleading results. While students from varying levels of rurality may not differ substantially from one another, geographic region and minority status within communities are likely to interact with individual-level variables, resulting in unique patterns of alcohol use and getting drunk.