Alcohol Consumption Among Urban, Suburban, and Rural Veterans Affairs Outpatients

Health Services Research & Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington 98101, USA.
The Journal of Rural Health (Impact Factor: 1.45). 03/2012; 28(2):202-10. DOI: 10.1111/j.1748-0361.2011.00389.x
Source: PubMed


United States rural residents tend toward poorer health than urban residents. Although alcohol use is associated with multiple medical conditions and can be reduced via brief primary care-based interventions, it is unknown whether alcohol consumption differs by rurality among primary care patients. We sought to describe alcohol consumption among urban, suburban, and rural Veterans Affairs (VA) outpatients.
Outpatients from 7 VA facilities responded to mailed surveys that included the validated Alcohol Use Disorders Identification Test Consumption (AUDIT-C) screening questionnaire. The ZIP code approximation of the US Department of Agriculture's rural-urban commuting area (RUCA) codes classified participants into urban, suburban, and rural areas. For each area, adjusted logistic regression models estimated the prevalence of past-year abstinence among all participants and unhealthy alcohol use (AUDIT-C ≥ 3 for women and ≥ 4 for men) among drinkers.
Among 33,883 outpatients, 14,967 (44%) reported abstinence. Among 18,916 drinkers, 8,524 (45%) screened positive for unhealthy alcohol use. The adjusted prevalence of abstinence was lowest in urban residents (43%, 95% CI 42%-43%) with significantly higher rates in both suburban and rural residents [45% (44%-46%) and 46% (45%-47%), respectively]. No significant differences were observed in the adjusted prevalence of unhealthy alcohol use among drinkers.
Abstinence is slightly more common among rural and suburban than urban VA outpatients, but unhealthy alcohol use does not vary by rurality. As the VA and other health systems implement evidence-based care for unhealthy alcohol use, more research is needed to identify whether preventive strategies targeted to high-risk areas are needed.

18 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Alcohol consumption patterns nationally and internationally have been identified as elevated in rural and remote populations. In the general Australian population, 20.5% of adult males and 16.9% of adult females drink at short-term, high-risk levels. Farmers are more likely to drink excessively than those living in major cities. This study seeks to explore the relationships between farmers' physical and mental health and their alcohol consumption patterns. Our hypothesis is that farmers consume alcohol at high-risk levels more often than the Australian average and that this consumption is associated with obesity and psychological distress. Cross-sectional descriptive data were collected within Australian farming communities from 1,792 consenting adults in 97 locations across Australia. Data on anthropometric measurements, general physical attributes and biochemical assessments were used to explore the interrelationships of self-reported alcohol consumption patterns with obesity, psychological distress, and other physical health parameters. There was a higher prevalence of short-term, high-risk alcohol consumption (56.9% in men and 27.5% in women) reported in the study compared with national data. There was also a significant positive association between the prevalence of high-risk alcohol consumption and the prevalence of obesity and abdominal adiposity in psychologically distressed participants. The prevalence of short-term, high-risk alcohol consumption practices in this cohort of farming men and women is significantly higher than the Australian average. These consumption practices are coupled with a range of other measurable health issues within the farming population, such as obesity, hypertension, psychological distress, and age.
    The Journal of Rural Health 06/2013; 29(3):311-319. DOI:10.1111/jrh.12001 · 1.45 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study compared common deployment-related health issues and correlates of mental health service utilization among rural and urban veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) living in Hawaii. Frequency of utilization of a broad range of mental health resources, including clergy/spiritual leaders, videoconference/online programs, and traditional/alternative healers, was also characterized. A random sample of 116 rural and 117 urban ethnoracially diverse veterans completed a mail survey. Rural veterans were more likely than urban veterans to meet screening criteria for posttraumatic stress disorder (PTSD), deployment-related concussion with persistent postconcussive symptoms, and alcohol use problems. Over one third of veterans who desired help for a mental health problem reported no current use of any services. Rural veterans were more likely than urban veterans to have accessed Veteran Readjustment Centers, but they did not differ with respect to utilization of other services. Correlates of mental health service utilization included higher education, PTSD, and lower mental-health-related quality of life. Results of this study underscore the need for dissemination efforts to enable OEF/OIF/OND veterans to access mental health resources. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychological Services 10/2013; 11(1). DOI:10.1037/a0032782 · 1.08 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Brief alcohol intervention, including advice to reduce or abstain from drinking, is widely recommended for general medical outpatients with unhealthy alcohol use, but it is challenging to implement. Among other implementation challenges, providers report reluctance to deliver such interventions, citing concerns about negatively affecting their patient relationships. The purpose of this study was to determine whether patient-reported receipt of brief intervention was associated with patient-reported indicators of high-quality care among veteran outpatients with unhealthy alcohol use. Cross-sectional secondary data analysis was performed using the Veterans Health Administration (VA) Survey of Healthcare Experiences of Patients (SHEP). The study included veteran outpatients who (1) responded to the outpatient long-form SHEP (2009-2011), (2) screened positive for unhealthy alcohol use (Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire score ≥ 3 for women, ≥ 4 for men), and (3) responded to questions assessing receipt of brief intervention and quality of care. We used logistic regression models to estimate the adjusted predicted prevalence of reporting two indicators of high-quality care-patient ratings of their VA provider and of overall VA healthcare (range 0-10, dichotomized as ≥ 9 indicating high quality)-for both patients who did and did not report receipt of brief intervention (receiving alcohol-related advice from a provider) within the previous year. Among 10,612 eligible veterans, 43.8 % reported having received brief intervention, and 84.2 % and 79.1 % rated their quality of care as high from their provider and the VA healthcare system, respectively. In adjusted analyses, compared to veterans who reported receiving no brief intervention, a higher proportion of veterans reporting receipt of brief intervention rated the quality of healthcare from their provider (86.9 % vs. 82.0 %, p < 0.01) and the VA overall (82.7 % vs. 75.9 %, p < 0.01) as high. In this cross-sectional analysis of veterans with unhealthy alcohol use, a higher proportion of those who reported receipt of brief intervention reported receiving high-quality care compared to those who reported having received no such intervention. These findings do not support provider concerns that delivering brief intervention adversely affects patients' perceptions of care.
    Journal of General Internal Medicine 02/2015; 30(8). DOI:10.1007/s11606-015-3218-5 · 3.45 Impact Factor
Show more