Individual and district-level predictors of alcohol use: cross sectional findings from a rural mental health survey in Australia

Abstract

BackgroundExcessive alcohol use is a significant problem in rural and remote Australia. The factors contributing to patterns of alcohol use have not been adequately explained, yet the geographic variation in rates suggests a potential contribution of district-level factors, such as socio-economic disadvantage, rates of population change, environmental adversity, and remoteness from services/population centres. This paper aims to investigate individual-level and district-level predictors of alcohol use in a sample of rural adults.MethodsUsing baseline survey data (N = 1,981) from the population-based Australian Rural Mental Health Study of community dwelling residents randomly selected from the Australia electoral roll, hierarchal logistic regression models were fitted for three outcomes: 1) at-risk alcohol use, indicated by Alcohol Use Disorders Identification Test scores ≥8; 2) high alcohol consumption (> 40 drinks per month); and 3) lifetime consequences of alcohol use. Predictor variables included demographic factors, pre-dispositional factors, recent difficulties and support, mental health, rural exposure and district-level contextual factors.ResultsGender, age, marital status, and personality made the largest contribution to at-risk alcohol use. Five or more adverse life events in the past 12 months were also independently associated with at-risk alcohol use (Adjusted Odds Ratio [AOR] 3.3, 99%CI 1.2, 8.9). When these individual-level factors were controlled for, at-risk alcohol use was associated with having spent a lower proportion of time living in a rural district (AOR 1.7, 99%CI 1.3, 2.9). Higher alcohol consumption per month was associated with higher district-level socio-economic ranking, indicating less disadvantage (AOR 1.2, 99%CI 1.02, 1.4). Rural exposure and district-level contextual factors were not significantly associated with lifetime consequences of alcohol use.ConclusionsAlthough recent attention has been directed towards the potential adverse health effects of district or community level adversity across rural regions, our study found relatively few district-level factors contributing to at-risk alcohol consumption after controlling for individual-level factors. Population-based prevention strategies may be most beneficial in rural areas with a higher socio-economic ranking, while individual attention should be focused towards rural residents with multiple recent adverse life events, and people who have spent less time residing in a rural area.

Psychological outcomes following the Victorian Black Saturday bushfires

“…Previous reports have noted the high rates of alcohol abuse in rural parts of Australia (Australian Institute of Health and Welfare, 2008), and it is probable that the elevated rates in the less affected communities can be explained by this factor. The observation that younger people and more men were more likely to be abusing alcohol is consistent with previous studies conducted in rural Australia (Inder et al, 2012), and highlights the need to address this issue in these subgroups.…”

Brazilian cross-cultural adaptation and validation of the List of Threatening Events Questionnaire (LTE-Q)

“…The association with substance use provides a convergent validation to the tool, as it is in agreement with a large body of evidence, which shows the relationship between environmental stress and substance use disorders. 36,37 Experiencing adversity seems to be a risk factor for the development of addiction of other substances as well, such as methamphetamine, opiates, and nicotine. 38 It is agreed that physiological stress responses may lead to increased alcohol consumption and the search for other psychotropic substances in the pursuit of self-emotional regulation.…”

Lifetime Affective and Alcohol Use Disorder: Impact of Comorbidity on Current Functioning and Service Use in a Rural Population

“…Participants were selected for interview based on their level of psychological distress using Kessler 10 scores [26] in order to obtain a reasonable representation in each category of psychological distress. Interviews were offered to 100% of those with a high-range score (25+), 75% of those with a moderate-range score (16)(17)(18)(19)(20)(21)(22)(23)(24), and one-sixth of those scoring in the low range (10)(11)(12)(13)(14)(15). A total of 636 (73%) participants completed a WMH-CIDI-3.0.…”

“…As in previous work in this area [47] the average age of our sample raises issues relating to potential recall, especially for lifetime alcohol problems, or generational effects, in an era when alcohol misuse was not the subject of public campaigns and treatment seeking was not addressed to the extent it is today. The ARMHS sample has a higher response rate from females (59.4%) and was under-representative of those aged 18-45 years.…”

“…Considering that mental health problems occur at a similar rate across geographical areas [20], and that higher rates of alcohol misuse are often observed in non-metropolitan areas [21], the challenges related to adequate service provision for comorbidity may be especially pertinent for rural residents. As disproportionate levels of disability have been noted for individuals with comorbidity [22], and in light of the lower service availability in rural areas, exploring functioning and wellbeing among rural residents with comorbidity may lead to important implications for future resource allocation.…”