Does Alcohol Use Differ by Metropolitan Status in Females Ages 25-44?

Purpose: Alcohol use can lead to serious health concerns and even death, but findings are inconsistent regarding whether risk differs by where people live. The purpose of this study was to determine whether alcohol use differs by metropolitan status in female adults ages 25-44. Methods: This cross-sectional analysis used data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) for females ages 25-44 in California (N=271), Colorado (N=428), Florida (N=1109), New York (N=1456), and Texas (N=482). Ordered logistic regression analysis was used with combined state data to assess the relationship between alcohol use and metropolitan status while controlling for demographic and health-related factors. Results: Across states, almost half of participants reported alcohol use (49-65%), about one-fifth reported excessive alcohol use (14-26%), few were smokers (8-20%) and about half reported mental health issues in the past 30 days (38-52%). Metropolitan status varied among urban (12-54%), suburban (24-51%), and rural (5-42%) residents. Adjusted results indicated that metropolitan status, current smoking, and mental health status were significantly related to alcohol use. Conclusion: Overall, alcohol use differed by metropolitan status in female adults ages 25-44, with urban women reporting drinking more than their rural counterparts. In a primary care setting, providers may expect half of young adult females to drink alcohol, half to have mental health issues, and few to be smokers. Providers need to be aware that current smokers and those with mental health issues are more likely to report alcohol use. Because alcohol use is related to metropolitan status, providers should screen for alcohol use in every woman aged 25-44, and especially those from urban areas. They should also include screening for smoking and mental health status when any of these factors are present, and provide education and referrals to substance abuse programs and mental health counseling as necessary.