Differential Effects of Neighborhood Type on Adolescent Alcohol Use in New Zealand

Identifying neighborhood typologies associated with adolescent alcohol use can inform the development of harm reduction strategies. Utilizing data from a nationally representative youth survey (n?=?4267) in New Zealand, latent class analysis was used to categorize neighborhood types (defined by 10 demographic, social and environmental indicators) to investigate their association with alcohol consumption and related harm. Three neighborhood types were distinguished: (1) “high outlet density and economic deprivation” (30 % of all neighborhoods); (2) “high deprivation, social disorganization, and unsafe” (38 %); and (3) “higher income, safe, and socially organized” (32 %). Significant ethnic variation was evident between neighborhood types. There was an age–group interaction in the main effects with significant associations between neighborhood type and drinking measures and harm most apparent among younger adolescents (<16 years), as described next. Compared to students residing in “higher income, safe, and socially organized” neighborhoods, the frequency of binge drinking and high typical consumption was significantly higher in students residing in “high outlet density and economic deprivation” and “high deprivation, social disorganization, and unsafe”, with students residing in “high outlet density and economic deprivation” also experiencing higher levels of alcohol-related harm. The findings that neighborhoods characterized by high deprivation and alcohol outlet density and low social organization and perceptions of safety were associated with risky drinking patterns and harm, specifically among young adolescents, underscores the importance of adopting a developmental approach to the study of contextual effects on adolescents.     

Neighborhood Psychosocial Hazards and Binge Drinking among Late Middle-Aged Adults

Older adults may be more vulnerable to negative health effects from alcohol as they age. Distress and adverse neighborhood conditions that provoke distress may influence drinking behavior. Using baseline data from the Baltimore Memory Study, a cohort study of adults aged 50–70 years living in 65 Baltimore City neighborhoods, we investigated the association between neighborhood psychosocial hazards (NPH) and the number of binge drinking days in the past month among non-abstainers (N = 645). We used negative binomial regression with generalized estimating equations to estimate the relative number of binge drinking days per month associated with a one standard deviation increase in NPH score. Residing in neighborhoods with more psychosocial hazards was independently associated with more binge drinking for females, but not for males. For females, each one standard deviation increase in NPH score was associated with a 1.52 relative risk of binge drinking (95 % confidence interval, 1.10, 2. 10) in the adjusted model. The findings were robust to a sensitivity analysis in which we used the average number of drinks per drinking occasion as an alternative outcome. Our findings provide evidence linking adverse neighborhood conditions with alcohol consumption in non-abstaining late middle-aged women, and suggest that late middle-aged men and women may have different reactions to adverse residential neighborhoods.     

Secondhand effects of student alcohol use reported by neighbors of colleges: the role of alcohol outlets

This is a study of the secondhand effects of student alcohol use experienced by residents of neighborhoods near college campuses. We examined the relationship of a college's level of binge drinking and the number of alcohol outlets in the immediate area, to lowered quality of neighborhood life through such secondhand effects. Adults from 4661 households in the United States were interviewed through a stratified list-assisted random digit dialing telephone survey. The interview schedule included questions about residents' experiences of secondhand effects of alcohol use such as noise, vandalism or public disturbances. Reports about the quality of neighborhood life provided by respondents residing near colleges were compared with those of respondents who did not live near colleges; and reports of neighbors of colleges with high rates of binge drinking were compared with those of neighbors of colleges with lower rates. The presence of alcohol outlets in these areas was also compared. Residents near colleges and particularly near colleges with heavy episodic drinking reported the presence of more alcohol outlets within a mile. Those neighborhoods were characterized by lower socioeconomic status. Neighbors living near college campuses were more likely to report a lowered quality of neighborhood life through such secondhand effects of heavy alcohol use as noise and disturbances, vandalism, drunkenness, vomiting and urination. A path analysis indicated that the number of nearby alcohol outlets was an important factor mediating the relationship between colleges, especially those with high rates of binge drinking, and such secondhand effects. The results suggest that neighborhood disruptions around colleges due to heavy alcohol use may be reduced by limiting the presence of alcohol outlets in those areas, and the marketing practices that this engenders.     

"Culture of drinking" and individual problems with alcohol use

Binge drinking is a substantial and growing health problem. Community norms about drinking and drunkenness may influence individual drinking problems. Using data from the New York Social Environment Study (n = 4,000) conducted in 2005, the authors examined the relation between aspects of the neighborhood drinking culture and individual alcohol use. They applied methods to address social stratification and social selection, both of which are challenges to interpreting neighborhood research. In adjusted models, permissive neighborhood drinking norms were associated with moderate drinking (odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.05, 1.55) but not binge drinking; however, social network and individual drinking norms accounted for this association. By contrast, permissive neighborhood drunkenness norms were associated with more moderate drinking (OR = 1.20, 95% CI: 1.03, 1.39) and binge drinking (OR = 1.92, 95% CI: 1.44, 2.56); the binge drinking association remained after adjustment for social network and individual drunkenness norms (OR = 1.58, 95% CI: 1.20, 2.08). Drunkenness norms were more strongly associated with binge drinking for women than for men (p(interaction) = 0.006). Propensity distributions and adjustment for drinking history suggested that social stratification and social selection, respectively, were not plausible explanations for the observed results. Analyses that consider social and structural factors that shape harmful drinking may inform efforts targeting the problematic aspects of alcohol consumption.     

Youth smoking risk and community patterns of alcohol availability and control: a national multilevel study

STUDY OBJECTIVE: To test whether college youth smoking risks are independently associated with community patterns of alcohol availability and control. DESIGN: Hierarchical multilevel multivariable modelling of cross sectional survey data. Outcomes included self reported current (past 30 day) cigarette smoking and heavy episodic (binge) drinking. SETTING: 120 nationally representative US colleges. PARTICIPANTS: 10 924 randomly selected students. MAIN RESULTS: Individual risks for smoking and binge drinking are independently associated with community patterns of alcohol availability, policy enforcement and control over and above individual perceptions about these factors, student and college characteristics, and school binge drinking rates. Youth exposed to high levels of alcohol availability are at higher risk of smoking (OR 3.61, 95% CI 1.75, 7.44) and binge drinking (OR 4.22, 95% CI 2.25, 7.93) than youth not so exposed; youth exposed to strongly enforced alcohol policy environments are at lower risk for smoking (OR 0.30, 95% CI 0.16, 0.57) and binge drinking (OR 0.17, 95% CI 0.10, 0.31) than youth not so exposed; youth exposed to communities with strong parental controls are at lower risk for smoking (OR 0.05, 95% CI 0.01, 0.23) and binge drinking (OR 0.06, 95% CI 0.01, 0.21) than youth not so exposed. Individual risks related to environmental exposures differ for youth with varying perceptions about alcohol availability and policy control. CONCLUSIONS: Drinking environments in US college communities comprise strong independent risks for smoking. Smoking prevention models should be tested that include environmental drinking prevention strategies tailored to underlying perceptions and experiences of college youth.     

Marketing a hard-to-swallow message: recommendations for the design of media campaigns to increase awareness about the risks of binge drinking

BACKGROUND: Binge drinking, commonly defined as having more than five drinks on a single occasion, is a public health issue affecting two thirds of Canadian young adults between the ages of 19-24 years. To educate young adults about alcohol poisoning, a network of 16 Ontario Health Units developed and implemented a mass-media campaign. The focus of this article is to report on post-secondary students' perceptions about key media campaign strategies, elements and messages for future campaigns designed to increase awareness about the risks of binge drinking. METHODS: As part of a multi-method process evaluation, nine focus groups were facilitated to explore the young adults' knowledge, attitudes and beliefs about binge drinking and the campaign messages. Participants were also asked to identify specific marketing messages and techniques that would increase their level of awareness about the risks of binge drinking. RESULTS: Participants recommended that campaigns be targeted towards parents and high school and post-secondary school students. Participants provided recommendations for the types of messages, images, and language they perceived would capture the attention of young adults. Television, posters and the internet were identified as key media channels for disseminating health information about the risks associated with excessive alcohol consumption. CONCLUSION: The problem of binge drinking is pervasive across Canadian campuses and students are largely unaware of the risks associated with excessive alcohol consumption. To reach this target population, it is important for future media campaign developers to utilize language, definitions, graphics and channels of communication to which this group relates.     

Associations of social capital with binge drinking in a national sample of adults: The importance of neighborhoods and networks

BackgroundWhile considerable research on adult binge drinking has focused on social influences, the potential role of social capital has been largely overlooked. This study examines the role of social capital, assessed in terms of both neighborhood and social network characteristics, in understanding adult binge drinking.MethodsAdults ages 30–80 were randomly drawn from the RAND American Life Panel and completed an online survey (analytic sample n = 1383). The main predictor variables were neighborhood cohesion, neighborhood order, and social network density. Associations of social capital with past month binge drinking (any, number of days) were examined, controlling for demographic characteristics.ResultsZero-inflated negative binominal regression analysis indicated that any binge drinking was more likely among adults who lived in highly ordered neighborhoods and who had denser social networks but was negatively associated with neighborhood cohesion. However, binge drinking was more frequent among those who lived in neighborhoods lacking order and who had sparser social networks, but had no association with neighborhood cohesion. Age was not found to moderate associations of social capital with binge drinking.ConclusionsGiven that the associations of social capital with adult binge drinking behavior appear to differ by level of influence and type of drinking behavior, there is a need to gain a more nuanced understanding of these complex associations, including the mechanisms through which they operate.     

Taking up binge drinking in college: the influences of person, social group, and environment.

PURPOSE: To identify person, social group, and environmental factors associated with uptake of binge drinking among a national sample of college students. METHODS: Using self-reported responses of students in the 1999 Harvard School of Public Health College Alcohol Study (CAS), we regressed conceptually important predictors of binge drinking onto a dichotomized variable describing uptake in the freshman year. This was a random sample of full-time undergraduates provided by the registrar at each participant school (n = 119). For this study, we analyzed data describing a subset of the total sample comprising first year students aged < or =19 years, excluding transfers (n = 1894). The student CAS is a 20-page voluntary, anonymous mailed questionnaire containing student reports about their alcohol and substance use, school activities, and background characteristics. Analyses included univariate and multivariate logistic regression adjusting for school response rate and using the Generalized Estimating Equations (GEE) in the Statistical Analysis Software package to handle the within-college clustering owing to the sampling scheme. RESULTS: College students who reported that they were exposed to "wet" environments were more likely to engage in binge drinking than were their peers without similar exposures. Wet environments included social, residential, and market surroundings in which drinking is prevalent and alcohol cheap and easily accessed. Findings held up in multivariate analyses that included variables describing person and social group characteristics. Students who picked up binge drinking in college also were more likely than their peers to report inflated definitions of binge drinking and more permissive attitudes about appropriate ages for legal consumption. CONCLUSIONS: Binge drinking can either be acquired or avoided in college among students who report they did not binge drink in high school. Reducing college binge uptake may require efforts to limit access/availability, control cheap prices, and maximize substance free environments and associations.     

Neighborhood social environment change in late adolescence predicts substance use in emerging adulthood

This study examines associations of changes in perceived and objective (census-based) neighborhood social environment variables during adolescence with alcohol and marijuana outcomes in emerging adulthood using two waves of data (2013–14 and 2019–20) from a cohort in Southern California (n = 1249). Increasing perceived disorganization predicted greater alcohol consequences and socialization with peers using marijuana. Decreasing objective neighborhood SES predicted fewer alcohol consequences and greater socialization with peers drinking alcohol. Unexpectedly, both decreasing and increasing perceived social cohesion predicted fewer alcohol consequences. Increasing perceived social cohesion predicted lower solitary alcohol use. Findings identify potential environmental targets to prevent substance use during the transition to emerging adulthood, but more research is warranted to understand the complex findings for alcohol consequences.     

Managing alcohol problems and risky drinking

While overall alcohol consumption and alcohol-related automobile deaths have declined, rates of alcohol dependence, liver cirrhosis, and alcohol-related problems remain high among adults, and binge drinking continues as a major health risk for high school and college students. Some individual-level downstream interventions have been evaluated with sufficient rigor to recommend widespread dissemination, and widened availability of new pharmacotherapies could further increase effectiveness. Midstream population-based programs, such as screening and brief interventions in hospitals and managed care organizations, may have greater public health impact than tertiary treatment because of early identification and low cost. Upstream programs and policies that place limits on alcohol availability (e.g., higher legal purchasing age) have the greatest potential to reduce morbidity and mortality at the least cost to society.     

Understanding Associations Between Neighborhood Socioeconomic Status and Negative Consequences of Drinking: a Moderated Mediation Analysis

We explored how neighborhood socioeconomic status (SES) is related to negative consequences of drinking to explain why racial/ethnic minority group members are more at risk than Whites for adverse alcohol outcomes. We tested direct and indirect effects of neighborhood SES on alcohol problems and examined differences by gender and race. We used data from the 2000 and 2005 National Alcohol Surveys (N?=?7912 drinkers aged 18 and older; 49 % female) linked with data from the 2000 Decennial Census in multivariate path models adjusting for individual demographics. In the full sample, neighborhood disadvantage had a significant direct path to increased negative consequences, with no indirect paths through depression, positive affect or pro-drinking attitudes. Neighborhood affluence had significant indirect paths to increased negative consequences through greater pro-drinking attitudes and increased heavy drinking. Subgroup analyses showed the indirect path from affluence to consequences held for White men, with no effects of neighborhood disadvantage. For racial/ethnic minority men, significant indirect paths emerged from both neighborhood disadvantage and affluence to increased consequences through greater pro-drinking attitudes and more heavy drinking. For minority women, there was an indirect effect of neighborhood affluence through reduced depression to fewer drinking consequences. There were limited neighborhood effects on alcohol outcomes for White women. Interventions targeting pro-drinking attitudes in both affluent and disadvantaged areas may help reduce alcohol-related problems among men. Initiatives to improve neighborhood conditions could enhance mental health of minority women and reduce alcohol-related health disparities.     

Neighborhood Characteristics of Alcohol-Related Pedestrian Injury Collisions: A Geostatistical Analysis

This study conducted a geostatistical analysis of ecological data to examine the relationships of neighborhood characteristics, including alcohol availability and alcohol consumption patterns to pedestrian injury collisions. The central research question asked whether it was possible to identify unique neighborhood characteristics related to alcohol- and non–alcohol-involved pedestrian injuries. It was hypothesized that greater numbers of alcohol-involved pedestrian injuries would be observed in areas with greater concentrations of alcohol outlets, even after adjusting for socioeconomic characteristics, environmental factors, and drinking patterns of neighborhood residents. It was also hypothesized that independent of drinking patterns and alcohol availability, greater numbers of pedestrian injuries would be observed in areas with higher unemployment, lesser income, greater population, and a predominance of younger or older age populations. Archival and individual-level data from a general population telephone survey were obtained from four California communities. The survey data included sociodemographic and drinking pattern measures. Archival data included environmental measures relevant to pedestrian travel and measures of alcohol availability. Units of analysis were geographic areas within each community defined by the spatial clustering of telephone survey respondents. The results showed that alcohol-involved pedestrian collisions occurred more often in areas with greater bar densities and greater population, and where the local population reported drinking more alcohol per drinking occasion. Pedestrian collisions not involving alcohol occurred more often in lower income areas with greater population and cross-street densities, and in areas having either younger or older age populations. The identification of neighborhood variables associated with pedestrian collisions has important implications for policy formation and targeted prevention efforts.     

Impact of Urban Neighborhood Disadvantage on Late Stage Breast Cancer Diagnosis in Virginia

Research suggests that residents of inner-city urban neighborhoods have higher rates of late stage cancer diagnosis. Identifying urban neighborhoods with high rates of both concentrated disadvantage and late stage cancer diagnosis may assist health care providers to target screening interventions to reduce disparities. The purposes of this study were to (1) create an index to evaluate concentrated disadvantage (CD) using non-racial measures of poverty, (2) determine the impact of neighborhood CD on late stage breast cancer diagnosis in US cities, and (3) to understand the role of obesity on this relationship. We used census block group- (CBG) level poverty indicators from five Virginia cities to develop the index. Breast cancer cases of women aged 18–65 who lived in the five cities were identified from the 2000–2012 Virginia Cancer Registry. A logistic regression model with random intercept was used to evaluate the impact of disadvantage on late stage breast cancer diagnosis. CBG-level maps were developed to geographically identify neighborhoods with both high rates of CD and late breast cancer staging. Over 900 CBGs and 6000 breast cases were included. Global fit of the concentrated disadvantage model was acceptable. The effect of disadvantage on late stage was significant (OR?=?1.0083, p?=?0.032). Inner-city poverty impacts risk of late stage breast cancer diagnosis. Area-level obesity is highly correlated with neighborhood poverty (ρ?=?0.74, p?<?0.0001) but the mediating direct and indirect effects are non-significant. Intervening in these high poverty neighborhoods may help combat disparities in late stage diagnosis for urban poor and for minorities living in these underserved neighborhoods, but more study is needed to understanding the complex relationship between concentrated neighborhood poverty, obesity, and late stage diagnosis.     

Comparison of assessment methods for self-reported alcohol consumption in health interview surveys

OBJECTIVE: To select a simple method for assessing alcohol consumption and to compare how different reference periods and response categories influence the self-reported frequency of binge drinking. DESIGN: Four random samples of 1000 adult Danes. Data were collected via personal interview at the respondents' home. SETTING: Denmark, nationwide. PARTICIPANTS: The total number of interviewed was 2593 individuals. MEASUREMENTS: The assessment methods in the four samples were (1) the 7-day recall method, (2) intake each day in a typical week, (3) intake last weekend, and (4) intake in a typical week. Furthermore, binge drinking was assessed in the samples using different reference periods and response formats. FINDINGS: The sex- and age-adjusted mean number of drinks in the last week (the 7-day recall method) was 10.6 drinks compared to 10.4 drinks among respondents reporting their intake for each day in a typical week and 8.7 drinks among subjects reporting the average intake in a typical week. Furthermore, subjects that reported their typical intake for each day were as likely as subjects that had the 7-day recall method to report a high weekly alcohol intake. Respondents who had close-ended questions were more likely to report binge drinking compared to respondents that had open-ended questions. CONCLUSIONS: Questions concerning typical alcohol intake for each day of the week are feasible to use in epidemiological studies. Furthermore, it is more appropriate to use close-ended questions compared to open-ended questions in measuring binge-drinking when the reference period is long.     

Trends in alcohol consumption in Singapore 1992 2004

AIMS: To present trends in alcohol consumption between 1992 and 2004 in Singapore. METHODS: Alcohol consumption data were derived from national health surveys conducted in 1992, 1998 and 2004. Age-adjusted prevalence of frequent (drinking 1-4 days a week), regular (drinking more than 4 days a week) and binge (having five or more drinks during a drinking session at least once in the month) drinking by gender and age group for the three surveys were compared. Multivariate analyses for binge drinking in 2004 were performed using logistic regression models. RESULTS: Prevalence of frequent, regular and binge drinking increased between 1992 and 2004. Prevalence increase in binge drinking was highest (from 5.1 to 10.0%), followed by frequent drinking (from 4.5 to 7.5%) and regular drinking (from 2.9 to 3.1%). Uptake in binge drinking increased in both genders and across all age groups but was most evident among adults aged 18-29. Frequent drinking increase was observed for both genders but was most pronounced among women aged 18-29. The level of regular drinking declined in men but increased in women, especially those aged 18-29 and 30-49. Being younger, male, separated, divorced or widowed, a current smoker, or having a monthly household income of S$6000 and above were attributes positively associated with binge drinking. CONCLUSIONS: Alcohol consumption, especially binge drinking, has increased among Singaporeans between 1992 and 2004. There is gender convergence in alcohol consumption.     

Patterns and Average Volume of Alcohol Use Among Women of Childbearing Age

Objectives: Maternal alcohol use is a leading preventable cause of neurobehavioral and developmental abnormalities in children. This study examines the patterns and average volume of alcohol use among U.S. women of childbearing age in order to identify subgroups of high-risk women for selective intervention. Methods: A sample of 188,290 women aged 18–44 years participated in the Centers for Disease Controls and Prevention (CDC)’s Behavioral Risk Factor Surveillance System (BRFSS) survey during the period of 2001–2003. Reported alcohol use patterns and average volume were examined for pregnant and nonpregnant women. Efforts were made to evaluate and characterize women who practiced various levels of binge drinking. Results: The results showed that approximately 2% of pregnant women and 13% of nonpregnant women in the United States engaged in binge drinking during the period of 2001–2003. Among the estimated average of 6.7 million women of childbearing age overall who engaged in binge drinking during the period, approximately 28.5% women also reported consuming an average of 5 drinks or more on typical drinking days, or about 21.4% women consumed at least 45 drinks on average in a month. Larger proportions of binge drinkers with high usual quantity of consumption were found among women of younger ages (18–24 years) or current smokers. Conclusions: Future prevention efforts should include strategies that combine health messages and encourage women of childbearing age, with particular emphasis on women 18–24 years, to avoid alcohol and tobacco use, and take multivitamins and folic acid daily for better pregnancy outcomes. Other efforts must also include broad-based implementation of screening and brief intervention for alcohol misuse in primary and women’s health care settings.     

广州地区高中生饮酒模式及过量饮酒的社会经济地位影响因素

目的 分析广州市高中生饮酒模式,探讨不同社会经济地位指标与青少年过量饮酒行为的关系,为制定控制策略措施提供依据。方法 采用多阶段分层随机整群抽样方法,抽取广州市4个区高一和高二学生共3 282人,采用自填问卷进行调查。结果 75.61%的学生有饮酒经历;过去一年内,60.22%的学生曾饮酒,27.67 %曾醉酒;过去30 d内,22.75%的学生曾饮酒,7.17%曾重度饮酒。总体上,男生五种饮酒行为流行率均高于女生,差异均有统计学意义(P<0.05);采用广义混合线性模型,分析不同社会经济地位指标对青少年过量饮酒的影响。结果显示,与家庭富裕程度低、学业成就高的青少年相比,来自家庭富裕程度高、学业成就低的青少年较可能有重度饮酒及醉酒行为。结论 广州地区高中生饮酒普遍化,提示防治工作的紧迫性,应及早开展健康教育和干预工作来减少酒精的可及性和青少年的饮酒行为。     

Alcohol use among adolescents and adults--New Hampshire, 1991-2003

Alcohol abuse is the third leading preventable cause of death in the United States. Because binge and heavy drinking increase the risk for cirrhosis, cancer, heart disease, stroke, injury, and depression, public health efforts have focused on reducing these patterns of alcohol use. The Council of State and Territorial Epidemiologists, the Association of State and Territorial Chronic Disease Program Directors, and CDC developed Indicators for Chronic Disease Surveillance, which provides a standard set of measures for alcohol surveillance. The New Hampshire Department of Health and Human Services used these measures to facilitate statewide trend analysis of alcohol use among adolescents and adults. This report summarizes the results of that analysis, which indicated that, in 2003, a total of 30.6% of adolescents reported binge drinking. In 2001, a total of 15.8% of adults reported binge drinking, and 6.3% reported heavy drinking. Interventions are needed to prevent adolescent drinking and to reduce excessive alcohol use among adults.     

Trends in alcohol use and binge drinking, 1985-1999: results of a multi-state survey

BACKGROUND: Alcohol abuse is a major public health problem in the United States. Binge drinking and drinking among youth are of special concern. The purpose of this study is to examine trends in alcohol use and binge drinking and correlates of the behaviors with a focus on drinking among persons 18 to 20 years of age. METHODS: Data are from telephone interviews of 449,110 adults aged > or =18 years residing in the 19 states that participated in the Behavioral Risk Factor Surveillance System (BRFSS) from 1985 to 1999. The percentages reporting current alcohol use and binge use (> or =5 drinks per occasion) were calculated by year, age, gender, race, and level of education. Data were analyzed in 2003. RESULTS: From 1985 to 1999, the prevalence of current alcohol use dropped 7.3%, and binge drinking dropped 3.3%. Among all age groups, most of the decline occurred before 1990. The greatest decline in both current (12.6%) and binge use (7.3%) occurred in the 18- to 20-year-old group. Between 1997 and 1999, however, respondents in this age group reported increases in these behaviors. Throughout the survey period, the proportion of current users who binge changed very little and remained highest among persons aged 18-20 years (52.1%). CONCLUSIONS: Alcohol use leveled off in the 1990s, but may be increasing, especially among persons 18-20 years of age. Those who drink are about as likely to report binge drinking as were drinkers 15 years ago.     

Problem drinking: rural and urban trends in America, 1995/1997 to 2003

OBJECTIVE: Studies examining trends in problem alcohol use for U.S. adults residing in rural locations are lacking. This study examines recent trends in heavy and binge drinking in urban counties and three types of rural counties. METHODS: Random-digit telephone survey of adults aged 18 years or older residing in states participating in the Behavioral Risk Factor Surveillance System, in the years 1995/1997 (n = 247,255), 1999/2001 (n = 362,077) and 2003 (n = 257,659). Analyses were performed in 2006. RESULTS: Metropolitan counties experienced higher prevalence of heavy and binge drinking than rural counties in all years, and all geographic areas showed upward trends in both drinking behaviors. Trends in heavy drinking were sharper in rural counties (3.8% to 5.4% compared with 4.9% to 6.0% in metro counties). Metropolitan and rural counties overall saw similar increases in binge drinking, however, the greatest increase occurred in remote micropolitan counties (12.7% to 15.7%). CONCLUSION: Heavy and binge drinking are problems that continue to increase in rural areas nationwide. Because of the difficulties inherent in accessing and administering substance abuse treatment in rural areas, special attention should be given to tailoring alcohol abuse interventions to the needs of rural residents.